I Do Not Think That Word Means What You Think it Means...

Indigo Montoya a great character is a great book made into an even better movie, says this to Vizzini when he utters 'inconceivable' one too many times while being pursued by the highly resourceful Man in Black. I find that quote is often useful.

I read a lot of history books. Some of them are good. Many aren't for a variety of reasons but the two most egregious reasons I hate a history book are either because it is revisionist history or filtered through modern perspectives. The latter is the hardest for a historian, I suspect. It's hard to put ourselves in the mindset of an earlier time. But we need to as often as possible. Particularly when discussing history.

The trigger point for this particular mental meandering concerns two books. One, arguably the greatest American fiction and another a history of events leading to the American Civil War. The word in question is not the one you might be thinking. It's the word that other word calls to mind - racism.

In modern usage we label essentially any ethnic generalization regarding relative worth as racist with all the negative connotations that generates. Implicit in our disgust with racist acts is the underlying notion that 'we should know better'. That is true today but I would argue that it may not be fair to those who went before us. I think this is important for at least two reasons. One, the prevailing wisdom of earlier times did not include modern knowledge that we take for granted and which we can rightly say, is readily available to anyone with an open mind. So to use our definition of concepts like racism is unfair to the majority of people who really, didn't know any better. Ignorance is not the same as racism, at least in the past. Like us today, most people went about their lives trying the best that they could with what they had.

The second reason is that using modern perspectives on the past just doesn't do a disservice to the average guy on the street. It does a greater disservice to those individuals of an earlier time who rose above convention. These are the people upon whose shoulders our modern conventions arose. We can pat ourselves on the back because of our 'superior' perspectives. But when you see what the pioneers really had to work with, it makes their efforts even more impressive.


Clear Priorities in Oregon

Wow. Our State's financial crisis threatens the collapse of education and public safety programs. But the Oregon legislature is tirelessly working on fixing our most pressing problems. It's not the looming crash but something far more important. It's expanding the rights of something that cannot speak for itself. I'm talking about guns of course. In addition to not killing people, guns can't talk for themselves or advocate for their rights. Fortunately Oregon's representative have got ya covered. Two bills passing through the tightly booked session wisely avoid any debt issues and concentrate on these really important issues.

1) Eliminating public disclosure of people who have concealed weapons permits. After all the privacy of anyone packing is far more important than the rest of the public knowing who outside of law enforcement is packing heat. We have maps of all kinds that allow us to gauge our safety but the privacy of the gun must be respected. After all, the Government could suddenly decide to confiscate the millions of guns in the nation's private arsenals though they'd be out gunned.

2) Honoring out of state weapons permits. We don't honor out of state medical licenses, nursing licenses, etc., but once again the rights of the gun must be preserved protected and expanded.

Way to go Salem! Glad you aren't getting distracted by trivia.


T-Shirt Ideas!

Ode to a Bag of Chemicals

The formulae of prose only for the whole?
Reserved for none but the total construct
Ignore the formulae with elements
No poet’s ode to chemicals and water?

I say nay for that is far to narrow
iambic here for what is at life’s core
And what really lies beneath to explain
Effects imparted by cupid’s arrow

As beautiful and wondrous as any art
no matter what medium or method
that one could use invoke or might apply
that the hand of man could to us impart

A dance of atoms that is so sublime
No choreographer could hope to match
No painter the dynamics could set in oils
And no poet as precise in any rhyme

I’ll harp more than once this very same refrain
Without any ambiguity to see
I am a chemical constituency
Dig down enough and it’s really quite plain

Dopamine helps motivate and rewards
Voluntary movement’s within its control
Learning, mood, memory, conditioning
As well as to whom we tend to lean towards

Epinephrine races the heart once smitten
Pupils large as saucers show the interest
Pulling blood from the less vital structures
Toward brain and heart by Eros’ shaft bitten

Serotonin our well being provides
Happiness provided by a monoamine
Though it really hurts when it is injected
Helps to ensure our food through the gut slides

Waves of potassium along an axon’s length
Depolarizing sections of membrane
An ionic semaphore like a byte
Affects the brains network with variable strength

I’ll harp more than once this very same refrain
Without any ambiguity to see
I am a chemical constituency
Dig down enough and it’s really quite plain

Actin and Myosin pull a tiny bit
But as they are legion my muscles flex
Compounded flickers move my fingers so
This prosaic message I can transmit

Testosterone leads to bolder actions
Sometimes that’s a good thing and sometimes not
Tis true it helps us find our life’s soul mates
But leads to troubles with other factions

This but a sample of the compounds about
Many more mindlessly act to make me me
That who I am could come from this, I think
Is a real miracle about which to shout

The particular shape aroma and feel
Of her bag of chemicals I know well
My chemicals recognize her any where
and build a life, I would not trade, that’s real

I’ll harp more than once this very same refrain
Without any ambiguity to see
We are a chemical constituency
Dig down enough and it’s really quite plain


Chapter, Line, and Universe

I fear that this may be one of those satires that Michael was talking about a few days ago ;). In any case it's a new Pliny story so you are warned

Cardinal Landrew was desperately short of time. If he didn’t act fast, the heretic sect would reach critical mass. His own flock was too close to the epicenter of the reimagining to have time to break off into another bubble. They would be consumed along with 2000 years of painstaking reality constructs that defined this region of the Multiverse. As Censor Bulla for the Roman Catholic Church it was his job to stop this from happening. It wasn’t charitable but he couldn’t help think, “Damn them all to my particular version of hell!” Why couldn’t they have taken precautions to trigger the event in one of the previously ravaged regions! He knew the answer of course. That wasn’t how it was done. Never. Birth was always traumatic. Particularly on a cosmic scale. Considering what they thought of the one true faith, Landrew was sure these heretics would be disinclined to make any special allowances for its preservation in any case.

New sect memes arose almost constantly. Most were not conducive or finely tuned enough to reach the levels needed to trigger a full on reimagining. This one was. The problem was that unlike most altmemes this one didn’t spread by conventional proselytization. If it had, steps could have, and would have, been taken to eradicate it like most of the others. The Censor Bulla remained a powerful body since the stakes were so high. It was true that they no longer had such effective means as the Inquisition and Crusades at their disposal but the Church spared little else in their support.

This movement had spread silently since the mental defect had originally been linked with a guilt meme and a self-preservation meme that had prevented the afflicted from sharing their particular good news with anyone. But during countless generations the guilt meme was no longer linked. And foolish relaxations of canonical law, induced by minor reimagining events, had reduced the influence of the self-preservation meme to a point where it no longer seemed to matter. That particular genie was out of the bottle.

Occasional memes had defied the usual measures and broken free. Sometimes the memes were compatible enough that only local disruptions occurred. But it was often a cataclysmic event. As an elder of the faith, Landrew knew of at least 3 such Class I events in the history of his own Altverse. Not including the one that had created it in the first place. In each, millions perished in the fires of re-creation. Those that remained were not completely spared since the residual effects of the schism left permanent changes. After all, some type of explanation was needed when a cosmic bubble expanded in your back yard tearing at the fabric of what had preceded it. No one knew how many other Altverses had sprung up in this way but scientists posited that the number was beyond comprehension.

Landrew didn’t care about those 10 to the 500th power apostaverses. His was the true one. He knew that chapter, line, and universe.

Most of these altverses weren’t particularly stable over time. That was a common problem with all the theoverses: Since they started in the mind of one heretic, only certain factors were altered in the re-imaging. The heretics were ignorant of the complete set of parameters needed to define a universe, too in awe of their own unique insight or too lazy to be bothered with the details, so they tended to simply cut and paste the myriad details needed to run a universe into the new bubble. If not the bubble fizzled rather quickly. That inattention to detail, of course, sewed the seed that often destroyed the new verse at some time in the future. Eventually, there would be enough mutations of the various memes present in the verse that someone would pick up on the inconsistencies.

It had happened in this Verse. Yes, according to the specification of this Verse, Adam had indeed lived 6000 years ago at the moment of creation, but since the architects of this reimagining (which the faithful referred to as ‘The Imagining’) had simply co-opted much of the Judeoverse, itself a construct of a previous reality, a great many nagging inconsistencies were present. The dinosaur bones were something that a lot of previous architects had overlooked. The Ark story meme considering their fate wasn’t a particularly compelling one for anyone over the age of 9. Emergency meme patches kept whole departments of the Church busy night and day. Closing minds to alternate verses was a tireless job but nothing was more important to preserving the fabric of reality. Much of the work seemed to involve a canonical shell game where some rules were reimagined as metaphors and metaphors were reimagined back into the literal. Working in the Holy Agency for Metaphorical Realignment tended to age one.

Landrew longed for the wrathful angel of God to descend upon the unfaithful but that had been a victim of the reimagining of this verse. That kind of divine firepower had been left behind in the Judeoverse. The marginally kinder and gentler gods of this verse used human avatars in robes to do their dirty work who also co-opted the myriad natural catastrophes and labeled them as one of God’s mysteries. That had been effective enough for centuries. He could invoke the Holy Spirit but that couldn’t penetrate the reimagined brains of the heretics. The individual’s brain became a small but separate Verse anytime they reimagined their own stars. As such it was immune to the specific rules of the parent Verse. That was why it was so important to control the education of the public and shield them from independent thought that could lead to cosmic upheaval. These intercranial Verses weren't completely immune to the basic rules of the parent Verse such as a body's need for oxygen and blood flow to their brains which could be interrupted without invoking the Holy Spirit. Landrew imagined a verse where that wasn’t a limitation but that would trigger the same kind of upheaval that was brewing even now.

Like we said before, a new Verse always started the same way in the past. It was created within the mind of a single individual from neurochemical imbalances, personal perceptions or for nefarious and self serving purposes. If caught at that point it was an easy thing to take care of. Eventually it would either peter out or start to gain dominion over other intercranial Verses and start to congeal. Combine enough with enough variability from the baseline parent Verse and a new Bubble might form. Sometimes the variations were mild enough that they kind of just rolled over the current verse like a gentle breeze altering some things but not disrupting too much. That had been the case with the Scientologists. Though odd and nonsensical the beliefs weren’t so far from the parent Verse to trigger a big bubble. After all, thetans and Catholic guilt weren’t all that dissimilar. Eventually they had all flown off in those cosmic DC-8’s searching for Xenu so things settled back down. The so called Reformation had been even less disruptive. Some effects had been obvious such as a general proscription against having any fun at all, drabber ceremonies and the ability of the priesthood to wed. Some were more subtle and long acting like Martin Luther’s last dig - a timed event that caused large numbers of pedophiles to enter the priesthood. It was unfortunate but the Church reckoned that the reimagined fix was too likely to trigger at least a class 2 reimagining event. Preservation of a universe required that the Church sometimes make sacrifices no matter how it pained them to do it.

That’s part of what made this event so much more dangerous. It hadn’t started in the usual way. No charismatic or insane person had single-handedly triggered this cascade. No, this one had seemed to spring forth from many locations at once. This meme was different. Landrew still thought of it in the traditional way. That might end up being the Church’s fatal mistake. They viewed the movement as the emergence of a new meme just like all the ones before. The difference was that this wasn’t the emergence of a new meme but the simple loss of one. That was why it prospered in so many different places. The affected individuals were very different but the end effect was the same. Once the meme in question had been lost, they all behaved in a similar fashion and began to reimagine the verse in a whole new way. They were many and close to reaching the threshold that would define a new Verse. In fact their numbers were far larger than needed to create a new bubble. They just hadn’t connected in enough numbers to accomplish it yet. But the damnable Internet was making that seem more likely with each passing hour.

No living person had actually experienced a true Class I reimagining. The last such event was centuries past and had left a large part of this world a desert where once lush lands had existed. Truth be told, a lot of that damage had been inflicted by an earlier event that had created The Imagining. But the histories were frightening. The emergence of a cosmic bubble around a nexus of reimagined reality could completely consume the parent if it didn’t pull away to an alternate dimension soon enough. Even in the best of circumstances, there would be residual contamination, often quite severe such as was the case of the last great bubble from the Middle East. Considering the trouble the mere residual created in The Imagining, Landrew could only imagine how vile the actual Altverse actually was (He had no way of knowing it but that Verse had recently been consumed in a hell fire of rebirth when 100 women had met in secret to discuss whether men were responsible for controlling their own longings.) If there was enough warning a new bubble could be created to escape the consumption. It was last resort and only a few of the faithful would be saved (around 110,000 at most). Landrew had been instrumental in getting the Church to commit to the slight reimagining (fortunately only an earthquake in an already godless region had resulted) that had allowed the True Church to adopt this useful escape clause from one of the minor perturbations that continued to fester from Luther’s first.

Even that option was off the table because of what essentially was a interruption of service attack. There were few seats in this cosmic lifeboat. Only the true faithful would be saved in this fashion. But so many people imagined themselves to be among that elite cadre, that the process ground to a halt.

These new heretics also seemed to be very adept at exploiting the recurrent fabric of The Imagining. Even more than the priesthood. It was a truly heretical concept but some had theorized that this Verse shared common ancestry with many such Verses all springing from a random eruption of energy. What nonsense. The priests had gotten a big bang out of it when first proposed by a long forgotten apostate. Archbishop Hoyle had been particularly amused.

But the abilities of the Greater Nonaligned Union, as they favored to call themselves, to make sense of the parts of the Verse that just didn’t conveniently fit with the rules of the Church, was truly disconcerting. Fortunately most believers had found sanctuary (or been steered to it) in the position of the advertising arm of the faith that claimed that they were just heretics, not the seekers of basic truth that they claimed to be. The apologists informed the masses that these were just competing ways of knowing - one was right of course and the other wrong. Not hard to pick which was which.

The Church was beneficent of course. The efforts to identify the particular cerebral defect that caused the troubles once they determined the level of the threat were substantial. For a long time no one believed it was possible. How could such a thing happen? How could such a creature continue to exist and reproduce? How could they have not called attention to themselves through violent and immoral behaviors lacking any overlords to keep them civilized? Every sentient creature believed in something, even if they were completely wrong in that belief of course. But these mutants believed in - NOTHING. No animism, no polytheism, no spiritualism, no one true deity. Nothing. Empty of anything save biting sarcasm and a seemingly endless list of so called transgressions and inconsistencies from the cosmic background structure of the Verse. Try as the Church might they could not get any theological memes to stick in the void within the minds of these creatures. They were so closed minded.

And they were threatening to ruin everything. Smarmy and cocky they were becoming ever bolder. At any moment, space itself could be torn asunder while they made one of their silly jokes and laughed about the fact that there was a gnu sheriff in town...

Row, Row, Row Your Boat...

Life is but a dream - or more accurately a neurochemical induced illusion. Some people don't believe in objective reality. They think, therfore it is... as they imagine it to be. It's a nice story but not true at all. We are surrounded by the proof.

Baby's don't need to be educated to accept gravity's dominion. The first time they roll over on the couch, the objective reality of gravity becomes apparent. Through repeated post acceleration impacts, the reality of gravity becomes law in even the most stubborn of humans.

In the beginning lore was needed to educate kids to not stand under that rock they just threw into the air. They didn't understand the invisible forces at work but were able to process the sensory feedback of headache when it returned to the ground, first striking them on the head. Generations later would be able to take that unerring observation and work out the math.

Lore served a useful purpose in that it was a form of history, often with practical morals attached. It's all we had for a really long time. Until science provided another way to define reality. Actually that isn't true. In fact the semantics of that sentence is the root of the problem. Science did not define reality at all. Science is a set of methods and practices that allows an observer to reliably document a set of observations, limiting as many variables as possible, so that reality can be clearly observed. These repeated observations allow a scientist to develop a predictive model that can be tested through additional observations to determine if the model can accurately predict what will happen. If it does enough times without fail, then we call it a model of reality. A model of reality. With time the model gets better and covers more and more levels of observation. Models predict future observations, not in the vague Nostradamus way of 'something will happen', but in the way that Darwin was able to predict that a particular butterfly and flower morphology would eventually be found in Madagascar. That's predictive modeling! Science doesn't define reality - it tries to describe what reality is with greater precision and accuracy. Gravity did not wait for Newton in the garden (Hmmm - revelations in a garden. Where have I heard that before. The tree of knowledge that dropped an apple on Issac's head, leading to the unraveling of the rainbow. Cast out from the garden of ignorance...)

Semantics are critical and often the problem. In a frustrating round at a blog I visit when I feel the need to be frustrated, there was another pointless round robin about emotions being something outside of the grasp of science. Nonsense. Emotions are neurochemical processes (some very pleasant in the same way as Ste B's Salvia no doubt...). But lore kicked in during antiquity and humans defined emotions as something otherworldly - spiritual. Spiritual is that place that things go to hide from critical study. Of course just because humans defined emotion in that way did not alter the fabric of reality. The neurochemistry is still the same. Dogged denial won't change that in the least. Emotions and other spiritual things resist science not because science has nothing to say about them but merely because people refuse to give up these artificial definitions that we have grown so attached to. But reality does not define emotions in that same way. And never will.

It's a common tactic against science. Claiming that it's just another way of defining reality. No it isn't. It is the only way we have of actually matching our evolving models of reality to what really is happening around us. The more we learn the less we trust our unadorned perceptions. Unless one's unadorned perceptions are central to one's notion of self, in which case nothing will dislodge that meme from its deep burrow. And just because our inner fantasy world is a construct of natural chemical processes doesn't make it any less of an enjoyable place to live.

So why could people give up the lore of gravity for the Law of Universal Gravitation? Simple. Gravity is not a construct of our mind. It doesn't define our very being or what we would like to think of as our soul. When scientists described the process by which that rock fell on your head, people could accept that this new theory fit with their own experiences. When neurochemists came along and said, 'here are the processes that occur when one experiences a reaction we have defined as love', people said 'no way'. "I know what I feel! It's not some organic chemistry! Its sublime and spiritual! You know, and other words that we made up to describe these sensations..." It's ok, even comforting, to think of grand processes like gravity that tirelessly work keeping things as they should be in an almost clockwork fashion. It's not so much fun to think that our minds are pretty much the same.


Framing Errors

There has been some good reporting recently on a particular form of cognitive bias called framing errors. (This should be distinguished from the way that computer programmers use the term. Here, we won’t be talking about the computer science problem of where a sequence of data is read starting at an incorrect point.) In our world, framing errors refer to differing decisions being reached based upon how data is presented to the user. Framing errors are a huge problem in medical informed consent and are heavily leveraged by litigators and juries. In fact, most legal proceedings involve the purposeful creation of framing errors on behalf of a particular client or viewpoint. Here's the scary part: almost everything you read about medicine in the popular media is rife with framing errors.

Let’s take a simple example: If an expert in epidemiology reported that exposure to substance ‘x’ over a ten year period would increase your risk of developing nose cancer by 33%, would you be in favor of draconian measures to prevent exposure to ‘x’? The answer should be, ‘depends upon the baseline risk of nose cancer within the population’, but that surprisingly is not how most people respond. If the baseline risk of nose cancer is 0.1% at ten years then the adjusted risk is actually around 0.133%. That seems a little less dire than a 33% increase. Said another way, after 10 years of exposure to ‘x’ there would be 4 cases of nose cancer per 3000 persons instead of 3 cases. The question of what one might be willing to tolerate for that reduction is very different from what one might consider to prevent a 33% increase without context. The moral of course is that all three ways of presenting this data are correct. But one gives a very biased perspective. Adjusted risks and incidence rates within a population are much better measures.

Let’s look at another example. Late night cable is awash with ambulance chasing liability attorney ads. A recent one is a great example. Some ‘non-attorney spokes person’ was bemoaning that a particularly advanced form of knee replacement prosthesis was associated with an 8% rate of failure. My golly - an 8% risk of failure? Sounds kind of high, and it may be; I’m no orthopod. But keep in mind that this is a knee replacement. You are replacing a worn out version of one of the most complex joints in the body. One subjected to huge stresses and of course being installed in less than stellar bone by definition. I’m actually surprised the failure rate isn’t higher to be honest. The litigator’s implication is that the failure rate is an example of poor design or malpractice during insertion. The assumption is that if some miraculous procedure unavailable to the last generation is less that 100% effective, it’s grounds for a lawsuit. Of course some of these same people would turn around in a lawsuit against big tobacco and claim that you can’t prove causation between cigarette smoke and a particular cancer.

As a doc my first response is that an 8% failure rate for a procedure that in essence is ‘polishing a ----’, ain’t that bad if a lot of people are walking as a result. The question should be how does this rate compare with other methods and what are the adjusted risks for the procedure. But that’s some of that pesky science that people seem to hate so much.

Framing entered into the pseudoscience surrounding vaccines as well. Enemies of vaccination claimed (a claim that has been subsequently completely debunked) that autism resulted from vaccinations at a rate of around 1 - 2 per 100,000 vaccinations. No one denies the tragedy of autism however, even considering the fact that the allegations were completely false, it would not have been clear cut even if they had been true. How can you say that Pliny!? Simple, the incidence of death and complications from the diseases that are covered by these vaccines is far higher than 1-2/100,000 in unprotected populations. We've forgotten that because vaccinations have been so effective and we haven't seen that kind of wild fire in a few generations. We are even now in the throws of an early outbreak of measles here in the NW - the US capital of Woo. It’ll be interesting to see how it spreads since out herd immunity is reduced around here by a lot of granola.

Another way people get exposed to framing confusion is through the use of confusing terms like cure, disease free interval, remission, survival, and quality of life. These terms show up a lot in oncology discussions and obviously mean very different things. Survival means exactly that. Is the person likely to be alive. Says nothing as to the status of the individual or whether the cancer is being kept at bay temporarily. Cure and disease free survival are more critical in making decisions. And these two are very different. For some specific kinds of malignancy, cure isn’t even a valid term. For others a certain disease free survival equates with cure.

Sometimes a patient is convinced to embark on a particular regiment for therapy by the promise of a extension of their survival. Almost never is the discussion had as to what that survival entails. Many think it’s 6 to 12 months of normal existence. It usually is not and a thorough understanding of the reality of those last weeks might change some minds.

Docs fall for this too. People talk about defensive medicine to avoid litigation but the risk is actually not nearly as high as most presume. Most of the time the risk can be minimized by good communication and documentation that addresses framing issues. I have this kind of discussion with parents of teen trauma victims all the time - the risk of occult injury with good examination vs the lifetime risk of radiation exposure from CT scans that very frequently add nothing to our management strategy even when a small positive finding is discovered. Too often my profession adopts some half backed policy to address a rare outlier rather than trying to educate the public or communicate with the patients.

With the application of evidence-based medical methods some of this should get resolved. These methods tend to be more directed at what serves a population most effectively. That means, however, that less emphasis will naturally be applied to the desires of one specific individual as it is today. But allowing unrestricted pursuit of any and all options no matter how marginally effective they are (backed by courts that encourage this notion) is a big reason why we are spending 2 trillion dollars each year and still only ranking in the 30’s or 40’s amongst nations with regards to our health and wellness.

So, next time you see some medical data, be careful to think about what it really means based upon the adjusted risk.


Where Nonsense Comes Alive...

Tonight at 10 pm on the History Channel, experts from the Templeton Foundation discuss the secrets of the Shroud of Springfield.


Death with Dignity

Though dignified people sometimes suffer,
there is no dignity found in suffering,
The last act of self-determination,
is blocked by many professing a god's love,
One's misery must serve as a lesson and,
must never be shortened by thine own hand,
Lest he demonstrate the depth of his love,
through eternal torment and endless fire,
The only lesson given is that we are,
but property to a divine caprice,
Might think differently were they the object lesson,
But true love will pay any price demanded,
your beloved from their pain to deliver,
The eternal torment is that emptiness,
Mere echos of her voice within can never fill.