Pre-Terminal Rants

While contemplating my eventual demise from Swine Flu, a number of rants demand to be aired. Being in healthcare it is inevitable that I will get exposed to this as it unfolds and being a long-standing asthmatic I ain't looking forward to it. However, medicine like soldiering has a big draw back - you don't get to choose your battles and stay home. So if Pliny goes dark any time soon, well - be excellent to one another.

Now onto some rants and raging against the dying of the light. Here in no particular order...

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Airline Insecurities

In our local paper the saga of a group of baggage handlers that ran a theft ring at PDX has been unfolding. Over the course of a couple of years these scumbags stole thousands of dollars of goods from people's luggage. The supervisor ratted them out but only after she stopped getting her cut. As usual the Internet was law enforcements best friend as these people once again demonstrated how much of an oxymoron 'criminal mastermind' is by fencing the stuff on ebay.

Ok this sucks. But the broader rant is this: while I have to navigate through TSA's cattle gates shedding articles of my clothing like that drunk girl at the start of Jaws, low life baggage handlers rummage through my stuff with impunity. At check in I get rousted to see if any strangers have touched my luggage, while gangs of the only strangers given access to my luggage rob our stuff in airline uniforms. If anybody wanted to pack something bad on a plane, the baggage handlers are a much more likely venue than old Pliny.

FIX IT TSA! I'm tired of inconsistency or at least admit that all this security stuff is just behavior modification to make us all passive. Or leave my belt alone. Until then, I will continue to wear those old mildewed shoes and put them into your little gray bin that pass within inches of your nose...
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Deficit-Spending Disorders

A friend ours is the fourth generation owner of a family business that electroplates metal parts. In their factory is this macabre setup with a couple of huge vats of hot acid where a lot of the work gets done. Over these vats is (was) a narrow catwalk for maintenance. It looked just like that set from the first Batman Movie where Jack Nickolson falls in to become the Joker.

They were fined and had to make the catwalk - over the hot acid vats - wheelchair accessible. My friends are good people (their parents began very aggressive environmental recovery actions years before it became law) and they argued that no one interested in that particular job had ever been wheelchair bound and that they had safety concerns. No matter - the law is the law!

I was reminded of this incident while watching a parent who is suing the school system while the State is considering cutting a month off the school year in order to survive a $5 billion dollar shortfall.
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Russian to my Aid

Why is everyone in Russia so obsessed with my masculinity? Every day I get close to 100 spam emails most of which offer some variation on Viagra or related alternative. (Fortunately no one is suggesting anything like how the elephant got his trunk!) Many are from Russia. What is this erectile obsession? I think I may have an answer. One that would satisfy Michelle Bachmann at least. As the image below shows, there must be a whole lot of these Russian engineers out of work and they obviously have experience with the challenge...

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My warranty and my patience is about to expired

Evey other day I get a call from USFideles warning me that my car warranty is about to expire and how happy they'd be to grant me a new one for some outrageous sum. I have an 8 year old Taurus that I bought used. I plan to drive it in the famous style of Richard Petty - "drive the somebitch flat out til it blows up". It hasn't reached the lawnmower 2-cycle stage yet (where you just add a can of oil to the gas when you fill) so its just dandy. Stay off my phone. My daughter has learned a new currency - how many Taurus's you can buy compared to the list price of other cars.
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Commissar you are

Ok Pliny has a really REALLY non PC hat. I admit it. Years ago Mrs Pliny had a special hat made for me. I've always loved those old furry commissar hats that Soviet Premiers always sport on May day. Mrs Pliny went to the library and had one made for me. Yes, Pliny wears a black mink hat when it's really cold. I also have this big thick long Kashmir coat that completes the picture. When I wear both I do look like one of those old commies. The West coast being what it is, I get some looks from the PETA crowd but for now my well practiced Germanic war face keeps them at bay - even with a mink hat. Unfortunately the thing fell off the shelf in the closet and my daughter is after me again. She has no idea what nasty little creature minks really are.

Ok, I wouldn't get one today but I'll be darned if I'll get rid of the one I have. It really is warm as can be. Now that they've gotten a couple of furriers put out of business through aggressive protests, they have some time on their hands - just leave my hat be.
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Foxing up the news

Fox news isn't carring the President's press conference live - they'd rather use the time to pull portions out of context and work on their ire... In related news the CDC published this explanation of the role hybrids have in allowing cross species infection such as the swine flu.

Plus the picture reveals Carl bemoaning a physical inadequacy of his...
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OMG! Is Obama really a Terrorist after all!!??

Dude! That's what Photoshop was invented for. I'm speaking to the rocket scientist who thought it would be just swell to get some pictures of AirForce One flying low over the Manhattan skyline. Particularly the one with the large airliner poised over the hole in the ground made by two other Boeing products. I would have thought they'd have covered that one in marketing 101.

Now you'll have to painstakingly edit out the thousands of screaming New Yorkers in the background running away like it's Cloverfield.

I'm surprised Fox hasn't accused Obama of ordering the plane to attack the Empire State Building or something equally rational.
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Can't you return to that undisclosed location?

Dick (name and descriptor) Cheney. Time to move on. Or maybe we can trick him and leave him stranded on that planet...














All right, that's enough for now. I feel better.

The Conservative Myth of Small Government

A cornerstone of conservative politics is a preference for 'smaller government'. Submitted for your consideration is a question: Is the notion of small government real or a convenient (possibly even a dangerous) myth?

It's a bit simplistic but essentially Mankind has been governed by four forces throughout history: mysticism, power, money and the law. None is a perfect solution with each saddled with limitations and dangers. At different times, the relative proportion of influence exerted by any one of these forces varies and it is also true that certain of these forces may co-opt others. Examples of the latter include theocracy's and authoritarian states. Mysticism, power or money based systems of power tend to corrupt their legals systems either by enacting new laws which further their reach or eliminating those extant laws which might mitigate or check their influence and power.

The fallacy in the small government philosophy is the assumption that less government (fewer laws) equates with reduced overall control in our lives. I.e., the other governing forces won't just expand to fill the resultant gap. History suggests that this may not be the result.

It also ignore the real possibility that these other governance forces may benefit directly from an elimination of legal restrictions to their power. This seems particularly true of our recent history.

A potentially valid assessment of the Reagan/Bush era is that reduced government simply lead to a greater proportion of our governance being handed off to economic interests outside of public oversight. As the current greed driven collapse of the economy suggests, this may have been a Faustian bargain.

My preference is the law, or the judicious use of representative government as a check on the other three. The law and government is an imperfect solution no doubt. A frustrating aspect of the law and governmental influences is that they are often affected by a wide range of divergent interests resulting in low progress and inherent compromise. But these compromises may prevent power from becoming too concentrated in the hands of a few - the usual outcome of economic governance such as that we we have now. It is precisely this frustration which can check governmental power.

More Torture

I have a very simple and effective ethical and moral test that I teach the surgery residents and PA's. Any time they are confronted with a difficult decision I tell them to recite the situation out loud but to precede the statement with the phrase; "Well, your honor, it was like this...". If it sounds hanky said that way, then it usually is. For moral situations I substitute; "Well, Dad, it was like this...". As simplistic as it sounds I have found clarity in this way in all manner of circumstances.

I bring this up because I can't help wishing W, et al. would have used this method when they were discussing torture. I hear a lot of discussions now on the news about whether torture is or is not effective. To be honest, I don't care. Because torture always fails the 'dad' test each and every time I think it through. It's just morally wrong.

People will always come back at me with the old, "but if you had to decide, yadayada, you'd probably think differently." maybe. I hope not, but that's not the point. We have government and laws because individuals don't always do the right thing particularly when it's hard. But shouldn't government represent us at our best, instead of our worst?

Torture

Right wing propaganda be damned we live in a country that uses torture.

The US has sanctioned the use of torture. Use all the lawyerly mumbo jumbo that you want but it is still torture. Any person who has choked on something going down their windpipe and remembering the pain and discomfort of it should have no problem imagining that having that happen repeatedly while your arms are tied, constitutes torture. Our government has executed captured enemies for doing the same things.

Torture is immoral. Show me evidence that God sanctions torture. Explain to me how torture is not 'cruel or unusual punishment' as defined in the Constitution. Torture is immoral. Where is the Christian outrage?

Prove to me that torture is a necessary evil. The right wingers including our ex-VP insist that without torture we are vulnerable. Prove it before you say another self-serving word. Prove to us that intelligence gathering, sanctioned police work, investigative techniques, you name it is worthless while only torture provides results. They make it sound like it's an either or - either we torture or we can't be safe - prove it.

Prove to us that torture even provides useful results. I mean results other than to dehumanize both the recipient as well as those who torture.

We know that there are evil people in this world who mean us harm - we'd just like to be sure that none of them are on our team.

The Bad Penny

I suppose I should be up front and disclose that I am not a fan of Dick Cheney. I'm sure that is shocking. Did anyone see the first part of Hannity's 'interview' with Cheney last night? It was on FOX, the voice of revolution, of course.

The Death Shroud

My career seems to revolve around circular story threads for some reason. When I went to work at the University Hospital I started noticing these little quilts that were about 3x4 feet in size. They showed up on top of the sheets covering the sick ICU patients. I was checking one out when a young ICU nurse decided to educate me about them. I guess she thought my smile was some sort of cynical response so she took it upon herself to defend the quilts.

"These quilts are made by hospital volunteers and we put them on the beds of our most serious patients. It is very comforting to the families". I was told. She stepped in front of me to straighten the quilt out - a nice effect.

"They get to take them home if they want to. Almost all of them do."

"It's a nice tradition", I said. "How'd it get started?"

"It started in the peds ICU, I think." she said. "Anyway we all think it's good for the families, where ever it came from."

I nodded and walked to the next room still smirking. No doubt she thought that I didn't appreciate the idea. Not true. Yes, it had come from the peds ICU of this hospital. But that's not the origin. The origin was at another hospital and began with the story of what was sarcastically labelled, 'the Death Shroud" by the ICU nurses at another area hospital.

I was part of a group of trauma surgeons at this other hospital a few years earlier. One of my partners and I talked a lot about how cold and impersonal the ICU could be particularly for critical trauma patients. We thought about several things but we liked one idea in particular- a trauma quilt. We asked a friend of ours who made quilts as part of a club if they would make us one if we supplied the materials. The club gladly obliged and produced a magnificent full sized quilt. It really was beautiful.

After a lot of eye rolling we convinced our partners to allow us to try out the quilt in the ICU. The rules were simple. Patients who were dying would be cleaned up and the quilt would be placed over their bed before the family was brought in to see them and say goodbye. The goal was simply to make things a little less impersonal at such a devastating time. The quilt was able to be cleaned of course and my partner and I paid for all expenses.

We presented the idea and the quilt to the nursing staff who pretty universally thought it was a really stupid idea. They called it the death shroud and some refused to have anything to do with it. But a couple went along.

After a few weeks the quilt was reluctantly used for the first time. We had it cleaned, and set it in its closet. Before we knew it, it was being used on more and more critical patients. And all the nurses were suddenly behind it. It had been in use for about 3 months before I really got to see why they had changed their minds.

I came into the ICU to see a badly injured young patient who was brain dead from a car accident. There was nothing that could be done. His family had been informed and were coming in to see him for the first, and the last, time since his accident. I had chaperoned far too many families to such a bedside. Not the way anyone would like to remember a loved one.

But I have to say I was stunned by the effect that quilt had. The technology in the room became almost invisible and the family felt comfortable huddling in close to him. Usually all the gadgets make people frightened to even touch their loved one for fear of messing something up. But all that registered was this young man secured under that quilt. It was amazing. I had no idea.

Before long the nurses had adopted the thing and took care of all its needs. They got a lot of positive feedback from families who strangely singled out the quilt in their thanks.

About a year later, we lost the quilt. There was a high visibility trauma case with many injuries and deaths. One victim who made it to the hospital was wrapped in the quilt when their family gathered around for the last time.

I was helping the nurses prepare the body when the patient's spouse came back in and gently took the quilt and held it close to their chest, walking away with the last thing that had held their loved one while they lived. We, of course didn't have the heart to try to get it back even though it was our only one.

Two days later we saw the quilt in the news. It was cleaned and draped over a quilt rack at the foot of the patient's coffin at their funeral. The survivor took it as the coffin was removed from the ceremony and carried it as before.

We decided of course to get another but then the nurses had a better idea. They had asked the volunteers at the hospital to make small quilts that could be placed on a lot more beds and given to the patient's family as a remembrance. The idea spread throughout the hospital and then the city. Before long, it wasn't restricted to just the most sick but showed up all over the hospital.

So the Death Shroud spawned many progeny. So many that their origins became obscured like all good things. They have come to provide far more comfort to the living than to the dead. They became a symbol of compassion, humanity, dignity and remembrance.

And with that short encounter in the University ICU, another circle closed for me.

Intangibles

I suppose the residents and students think it’s some kind of personality quirk but each time we enter an ICU room to examine a really sick patient who is obviously obtunded - out of it, I first take their hand (after washing mine, of course), smile and tell them we are going to talk shop about what we need to do today to make them better. Before we leave the room I repeat the ritual and tell them we’ll see them later. It slows down rounds a bit but I don’t care. I also insist that when they present to me that they use the patient’s formal name as they speak. I’ve performed this ritual for more than 20 years now. The seed for this was planted on the very first day of my internship.

I came to work that day beaming with pride and excitement. I’d landed a residency position at a very prestigious surgery program. It was my first choice. I’d done so may clerkships at this hospital that many people thought I was already a resident. The excitement turned to abject terror over the next few hours as I was introduced to my first rotation - cardiothoracic surgery. I was the only intern assigned that month to a cardiac service with 5 busy surgeons performing 7 - 11 major cases per day. I was responsible for rounding on all their ICU patients - they had their own ICU of more than 20 beds. I pretty much lived there for that month.

And on that first day I saw her for the first time. I was told it was a her though from the bedside it was hard to tell. In the bed before me was a middle-aged woman who had had a heart attack that rendered her heart incapable of sustaining her life. Whether she would recover was doubtful. For now she was on every device and drug known to man trying to keep her alive from moment to moment. She was heavily sedated and had the very glassy eyed look of the very sick. She didn’t seem to respond to any stimulus except in a sort of reflexive manner. As the macabre saying goes, ‘the lights were on but nobody was home’. She was on a ventilator. From the artery in her left groin, an intra-aortic balloon pump threaded into her chest received a burst of nitrogen that inflated it each time the valve between her heart and aorta closed.

From her open chest cavity you could see her heart beating under the dressings. Two large tubes took blood from her right heart, circulated it through a VAD, a ventricular assist device; essentially an artificial heart, and returned it to her body. A similar set did the same to her left heart. Tubes and catheters tracked from her bladder, her stomach. It seemed nightmarish to me at the time.

And I had to examine her and care for her each day. I was scared to death of doing something wrong. Where to begin an exam on such a patient. Each morning I started rounds at her bedside. Being in over my head and completely clueless as to what I should be doing, I guess I reverted to the simple defense mechanism of smiles and pleasantry which allowed me to gain favor with the nurses who knew so much more than I did. As they guided me in my assessment I instinctively grabbed the patient’s hand and smiled as they gave me report and nudged me in the right directions. It was nothing but instinct - one that served me well. This went on for almost 3 weeks. Surprisingly she slowly recovered, came off all the support devices and went off to the ward to mend though she was still very obtunded and unable to think clearly. I went off service and that was that.

Well, not quite. Three years later I was walking down a long hall that separated an old part of the campus from the new. I had learned a lot in those years but had been humbled many more times as well. Nevertheless, I had reached a point when I could actually provide some reasonable care. I was not having a good day. I was having some second thoughts about whether this path was for me. I wasn’t all that sure that I was doing any good.

That hall was one of my favorite parts of the hospital. Out the window was this old smoke stack that no longer had any purpose. From its top grew this little tree. Administration always wanted to cut it but it had become our mascot - a symbol of life’s endless ability to endure. Not a bad symbol for a hospital. I was walking and smiling to myself as I looked out at that tree.

From the opposite direction a gaggle of suits was trotting along behind the CEO of the hospital and some woman of obvious import to the suits. Normally, I wouldn’t have given it much thought but the woman with the suits was absolutely stunning. She was one of those people who was both beautiful but also radiated grace, power and intelligence by the way she walked down the hall with an elegant stride that reminded me of the way a great cat glides along.

She was explaining something to the suits when I caught her eye and she stopped mid-sentence. She walked over to me and said the first astonishing thing; “Dr, [pliny], is that you?” I fumbled a simple affirmative and (doing the second astonishing thing) she immediately hugged me tightly. Not being used to such attention by Sophia Loren types, I was a bit off my game.

She said, “You don’t recognize me do you?”. Before I could grab the shovel to dig myself deeper, she graciously said the most astonishing thing of all. “I’m so and so”. Being the slick guy that I am, I uttered, “No Way!” She laughed and hugged me again. The CEO and the suit minions were a bit perplexed and uncomfortable by now, so she explained to them while never taking her eyes away from mine.

“I was hoping I’d get to see you and thank you for saving my life.”

I started to correct her as to my extraordinarily limited contribution when she stopped me.

“I was so sick and was afraid I was going to die. But each morning you would walk in with a big smile and I knew I would make it one more day. As long as you were smiling I was going to make it.”

I was shaken to the bone. Me, lowly and least of all the people who cared for this woman who obviously was more awake than we dared imagine, had become her link back from the edge. I learned the power of small things and seemingly trivial kindnesses in that moment.

I never saw her again, except in the face of every sick patient for more than 20 years...

Always with the Negative Waves Moriarty!

I think last night after looking at all the angry people participating in the well orchestrated outpourings of spontaneous emotion surrounding the teabagging, I finally realized what essentially distinguishes me from the neocon's - hope.

These guys are pissed off all the time. The only way you can be pissed off all the time is if you don't think anything can ever get better than it is right now, and, to distinguish this from simple contentment, you have to be certain that everybody else is dedicating their lives to taking what little you do have, away. To take a neo-conservative world view, be it political or theological, is in my view to surround one's self with negativity. Change becomes not a force for potential enlightenment but rather just another form of erosion. That which is good cannot become better, it can only be etched away by events which result in the diminution of what came before. I find that sad.

I can't help being an optimist. I have hope that we have come no where close to where we will go. I have no doubt that a hundred years from now enlightened people would think me a narrow-minded dinosaur. And being the bleeding heart old liberal that I am, the thought of that, makes me smile... How can I be sure this can happen? Look around, "we've got an army!"

Ownership and Efficacy: Who Owns the Medical Record, Part 2

Debates on the ownership of the medical record (and the maintenance implications of said ownership) usually involves security, portability and autonomy concerns. One of the things rarely mentioned is the issue of efficacy - how useful is the record and how accurate is it? Over a couple of posts I hope to stir your cognitive juices a bit to consider this neglected consideration and why it may soon become a major driver of this debate.

It probably comes as no surprise that there are errors in medical records. A thing that would probably surprise most people is that aside from billing and employment issues, errors in your medical records may or may not have a significant clinical impact. How can that be true?

It’s pretty simple really. Clinicians are overwhelmed with information, or to be truthful, data. To a certain extent information overload is a double edged sword. It’s bad if you fail to incorporate a critical component from the record into your decision-making and good if you ignore an erroneous one. That's not terribly comforting nor should it be. The real world is often not for the faint of heart.

But that may be about to change. If Pliny and his minions have their way, the next five to ten years will see a dramatic change in how medical records are stored and more importantly used. The game truly is afoot and clinical research in the use and implications of an entirely new generation of medical information technology is underway. If successful, politically as well as technically, it will have a big impact on medical records. [A word of disclosure here. Although I have a vested interest in the outcome of this research it is all being conducted by independent investigators. Corruption awaits any who are not vigilant to avoid temptation.]

So what’s the big deal? These experimental medical records systems have a significant advantage over their predecessors; they are intelligent. No not in the Hal 9000 or TNG Data fashion but pretty interesting all the same. What does that mean? It means instead of just stuffing data into a record and having it sit there like what happens in paper charting or existing electronic health records, all the data stored in the system is reviewed behind the scenes by a powerful artificial intelligence (AI) system. This AI is able to remember everything that was ever entered into the medical record about you and all that is newly added. This changes the game. These AI systems, being completely embedded in the medical record, can assist with diagnosis, selection of therapy in light of a patient’s existing history, test selection, chronic disease management, clinician and patient education - essentially all aspects of healthcare depending upon circumstances. They can also change their behaviors and the way they communicate based upon the educational training background of the user and their language. Some aspects of patient care and management will be manageable by the patient themselves using either Internet portals or more likely personal electronic devices such as cell phones (watch the itunes store around August 15, for a glimpse of the future...). The systems basically allow a clinician to be aware of everything of relevance in the medical record as well as a knowledge base of medicine equivalent to thousands of physician lifetimes.

All this sounds like fantasy but over the coming year the first peer-reviewed data showing the efficacy of this will be coming out. The technology has been shown to work. Now there remains an enormous amount of work to get it fully implemented.

Circling back to the to the issue of the efficacy or clinical usefulness of the medical record, it should be fairly obvious why we should have concerns. The new AI systems will for the first time ever, be able to process the complete body of knowledge stored about a patient with the purpose of actually basing recommendations upon such a complete review. And not just the data stored in the records at hospitals and clinics but also the personal health record or PHR. PHR data has never really been used to effect patient management before. If there are errors, the recommendations of the AI may be compromised. Mitigating the threat posed by such errors has been a challenge we have been working on for some time, but a key factor in this discussion will be who is charged with, and therefore carries the responsibility for the accuracy of the data? Here's the rub - the owners of things usually are responsible for their maintainence. With portable dynamic medical records that adds a whole dimension to that challenge.

In a later post I’ll share an exercise I used in in an adult learning class to evaluate the possible candidates for role of keeper of the record dealing mainly with the issue of conflict of interest. What may be the biggest surprise is who may have the least conflict - and who the most.

Pliny's Live Feed: Does this mean it's now 'General So's Chicken"?

First in a new series of true life dramas about the wacky world of American democracy across this land. Articles will only come from reputable news sources and the only modification will be the addition of italics or bold text for my bemusement. This first feed is from the State of Texas where the fate of school biology textbooks hangs in the balance. This one will make you feel confident in the outcome.
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From the Houston Chronicle and the Associated Press:

Lawmaker defends comment on Asians
Call for voters to simplify their names not racially motivated, Terrell Republican says
By R.G. RATCLIFFE
April 9, 2009, 11:58AM

AUSTIN — A North Texas legislator during House testimony on voter identification legislation said Asian-descent voters should adopt names that are “easier for Americans to deal with.”

The comments caused the Texas Democratic Party on Wednesday to demand an apology from state Rep. Betty Brown, R-Terrell. But a spokesman for Brown said her comments were only an attempt to overcome problems with identifying Asian names for voting purposes.

The exchange occurred late Tuesday as the House Elections Committee heard testimony from Ramey Ko, a representative of the Organization of Chinese Americans.

Ko told the committee that people of Chinese, Japanese and Korean descent often have problems voting and other forms of identification because they may have a legal transliterated name and then a common English name that is used on their driver’s license on school registrations.

Easier for voting?
Brown suggested that Asian-Americans should find a way to make their names more accessible.

“Rather than everyone here having to learn Chinese — I understand it’s a rather difficult language — do you think that it would behoove you and your citizens to adopt a name that we could deal with more readily here?” Brown said.

Brown later told Ko: “Can’t you see that this is something that would make it a lot easier for you and the people who are poll workers if you could adopt a name just for identification purposes that’s easier for Americans to deal with?”

Democratic Chairman Boyd Richie said Republicans are trying to suppress votes with a partisan identification bill and said Brown “is adding insult to injury with her disrespectful comments.”

Brown spokesman Jordan Berry said Brown was not making a racially motivated comment but was trying to resolve an identification problem.

Berry said Democrats are trying to blow Brown’s comments out of proportion because polls show most voters support requiring identification for voting. Berry said the Democrats are using racial rhetoric to inflame partisan feelings against the bill.
“They want this to just be about race,” Berry said.

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Also from the Chronicle, a surprising change of heart.

AUSTIN — A Texas lawmaker under fire for saying that Asian-American voters should adopt names that are “easier for Americans” has apologized for her remarks.
State Rep. Betty Brown, R-Terrell, issued an apology Thursday for the comments made during a House Elections Committee hearing on April 7.

Brown said the remark came during a conversation on the difficulty of translating names and that she was referring to transliteration issues when she asked a representative of the Organization of Chinese Americans whether Asian-Americans could adopt names that “we could deal with more readily here.”

Ramey Ko, the representative, had testified that people of Asian descent have problems voting because they sometimes list legal names that had been transliterated in addition to common English names on their driver’s licenses or other identification.

Brown said she was not asking Ko to change his name.

New York City Councilman John C. Liu, who along with the Texas Democratic party had called on Brown to apologize, said in a statement that the apology was “a fair first step,” but didn’t go far enough. Liu said Brown’s comments during the exchange with Ko went beyond the concept of transliteration.

Brown said in her apology that she understands the “diversity of Texas” and the “enrichment” that Asian-Americans have brought to the state.

Her spokesman, Jordan Berry, told The Associated Press on Saturday that Brown’s comment was being used by opponents of voter identification to obscure the real issues involved.

“Ninety percent of Texans — Republicans and Democrats — want the voter ID legislation,” he said, referring to a bill recently passed by the state Senate that would require photo identification to vote. “Let’s move forward.”

National Yellow Cake Day!

Today lots of snarky pseudo-conservatives are protesting the Obama stimulus bills with mock tea parties. It's very appropriate that they substitute some inane symbolism for actually having any idea how to properly govern. But the more old Pliny thinks about it the more I think it might be a good idea. So Pliny proposes that May 15 of this year will be a day when the rest of us celebrate the previous administration's, and it's media lap dogs, legacy of lies and subterfuge. I am calling for a National Yellow Cake Day! On this day, all true friends of democracy and liberty will eat a piece of yellow cake to commemerate the costs of accepting disinformation on face value. What say you!? Are you game! If so we need to spread the word and organize the effort. Participating sites may proudly use the yellow cake emblem below.

My new Hero

http://www.youtube.com/watch?v=9lp0IWv8QZY

Personification of the old adage; "you can't judge a book by its cover".

Hamburgers Florentine

A while back I promised pboy a simple recipe for the best darned hamburger on the planet - so here it is - Hamburgers Florentine!
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Ingredients:

• 3/4 pound of ground beef (10-20% fat)
• 2 garlic cloves
• 1 tbls of sea salt
• 1/4 tbls fresh ground pepper
• I/2 fresh lemon

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Instructions:

Fashion 3 patties and leave them fairly thick. If you use really lean ground beef they will be too dry. You need the juices for this to work well. Mix the salt and pepper together and coat both sides of the patties with the mixture. Mix up some more if you run out. Cut the garlic in half and rub it on a burger sized of piece of wax paper. Immediately apply the wax paper to one side of the burger. Repeat the process for both sides. You can rub the garlic on the burger directly but I find that it's hard to do right without the paper trick.

Grill the burgers. Frying them is against federal, state and natural laws. Don't burn them or cook the life out of them. Best in the medium range.

Place the burgers on a plate and squeeze out the juice of one half lemon on to the three eagerly awaited masterpieces. Let sit for 5 minutes them serve 'em up. Putting anything on them is sacrilege. Partake of the burger of the gods.

e-Malebolge

In the first part of Dante's Divine Comedy, the eighth circle of hell is reserved for the fraudulent - cheats, false counselors and liars to name a few. When in the grip of another bout of insomnia-induced Internet surfing, I can't help but think of the blogosphere as its modern incarnation. Can there be a period in human history where more excrement came pouring out of the mouths of more people? Can't recall any. In some part I have to think that the frightening rise in pseudoscience around the world is due in no small part to the corossive and self-reinforcing aspect of a lot of Internet content. Four things become very easy in the modern information age (other than the the obvious obfuscation of facts). One, there are no longer any filters to publication of anyone's thoughts or perspectives. Two, it has become very easy to find similarly inclined individuals who reinforce these perceptions. Three, people's discomfort with uncertainty can be salved by reading strongly opinionated drivel playing fast and loose with the facts, And four, other than intramural derision there is little in the way of policing. These faults explain in part why false ideas such as ID creationism and shamanism have become harder to eradicate than crab grass.

Those with only a passing acquaintance with truth have come to believe (unfortunately not without justification) that volume and popularity ultimately decide what the average pliable brain will come to accept. This is intolerable.

I can't do anything to fix this other than to fix this little spot in the fray. I won't promise not to post any lame poems or satire that misses the mark, but I will work toward doing a better job of citing the peer-reviewed references for my posts and being clearer about what is well established vs more anecdotal. From time to time I also plan to present a candidate site or two that deserves to be consigned to e-Malebolge and would urge you to do the same. But if you are thinking of nominating Focus on the family or the Discovery Institute sites they are disqualified - they have already been consigned to the ninth circle of hell.

Do You Own Your Medical Record?

It seems like a simple question. Certainly policy wonks and advocacy groups make it seem so. Before I tell you what I think, I'd like to know your thoughts, as well as why you feel that way. In about a month there will be a round table of researchers in data management and structures in Washington D.C. discussing long term approaches to medical information flow and management. Who owns the record will be one of the factors that will influence the direction taken.

The Path is Revealed: Life's Guiding Principles

Pliny has to admit that sometimes life seems way too hard. Our minds become flooded with distractions and it's easy to lose sight of what we should be doing or from where we should be seeking our answers. But Pliny is here to help. Below is the Path - or I suppose I should say Pathway Protocol. This is an algorithm for life - a lifegorithm if you will. The Tao of Pliny. When confronted with a new experience or observation simply follow the diagram from left to right and find your particular spiritual niche. Once you do, just follow the color coded lines to find either places to seek answers or how best to respond.

The dotted lines represent options (don't worry, unless you are religious there aren't all that many to taunt you) while the solid lines are 'must do's'. Print a copy and keep one by the TV, the radio and the phone for rapid reference; any place where you are in danger of new experiences. Demand that your kids refer to it before asking you any silly questions about evolution, philosophy, or any other challenging topic. Before you know it, you'll have this committed to memory and this being America, you are unlikely to ever have to switch paths.
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Useful clues: If even this seems too complicated, then s-l-o-w down and take a deep breath. Here are a few tricks that will help.

• If you look at the protocol and become really mad, select the red diamond.
• If you get really mad on behalf of some deity, select the orange diamond.
• If you are confused by it all, select the green diamond.
• If you can't find 'the Bible' on the chart select the orange diamond.
• If you believe in ghosts except for the Holy Ghost select the blue diamond.
• If you are certain you are not going to hell select the orange diamond.
• If you watch Fox for its fair and balanced reporting select the red diamond.
• If you are someone who likes to keep their options open select the yellow diamond.
• If you look at the sum total of human history and are amazed we are still here select the violet diamond.
• If you insist on teaching the controversy select the orange diamond.
• If you are a Unitarian select the blue diamond.
• If you try to rationalize the roles of science and religion select the yellow diamond.
• If you submit blog responses completely in all caps select the red diamond.
  

Those to the left of the diagram might want to white out everything after fundi and substitute Satan.
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PathAQ's answers about the answer

1. If I'm a fundamentalist obviously I can't seek answers in science according to the pathway. But can I seek services from science? Of course you can! This is America! Consistency isn't required. Just be sure to seek these services from people who's niche has a wave length below 450 nm - and be sure to never give them credit for a positive outcome.
2. What if I really can't make up my mind? No problem again - just assume the niche of your favorite film, TV or sports star. After all, they're famous and you're not so they must know more than you.
   
3. I think I'm amystic but I read the horoscopes in the newspaper. As long as you don't invest money or make career choices based upon them, no problem - take the violet line.
4. My significant other is in a different niche. What should I do? Bail. relationships outside of one's spectral range are doomed at the quantum level.
5. Being religious seems to be the most flexible and varied experience. It certainly is. Through the wonders of compartmentalization yellow line passengers can avail themselves of most of this worlds bounty depending upon circumstances and social setting.
6. This process seems a bit cookbook to me. Well, unless you are a philosophical epicure of the highest order, aren't you better off using someone else's recipes?
   

Now, admit it - isn't this easier and a load off your mind? In later posts I will add additional protocols covering other topics such as when to eat, sleep and go to the bathroom.
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Have a great weekend all - I will be doing battle against crane fly grubs using my manly yard fork!

Things That Go Bump in the Night 1.0: Conventional Trident Missiles

There are times when I wonder if I am not part of a different species. The debate and ongoing interest in the Pentagon's desire to arm a small number of the Navy's Trident 2 submarine launched ICBM's with conventional warheads certainly triggered that sentiment. Before I go into this frightening saga, a couple of things need to be said. Technically, this plan was allegedly terminated by Congress in 2007, but based upon a few bread crumbs I discovered, one could infer that it has merely gone underground or under a new name. I can't really tell and it's not something that I can call the Pentagon and ask them. I'm on enough lists as it is... So why bring this up if I'm not sure it's still an active program? Because while we go about our lives and struggle with the economy, people keep coming up with bonehead crap like this that puts us all at risk. And it's got to stop. This is the kind of story that shows up as a couple of paragraphs from the AP on page 9 below the Walmart ads. Some of the scariest stuff barely rates a comment - particularly if we are enthralled by the latest Scott Peterersonesk exploits.

Background

During the Bush years (my isn't that the preamble for a whole lot of bad ideas...) the Navy came up with a plan to remove the multiple warheads from a couple of its long-range Trident 2 missiles and replace them with conventional ones. This all came about in the wake of the debate about Tomahawk cruise missiles having missed killing Ben Laden because of their slow speed (around 500 mph), limited range (~1500 miles) and long time to target. Ships carrying Tomahawks had to be positioned pretty close to where the target are to have a shot. A submarine launched ballistic missile could cover thousands of miles in minutes so technically it could solve these problems. This would give the President a rapid response weapon of considerable accuracy that he or she might use to kill off some unsavory enemy- at the expense of creating a couple of new problems which you clever readers probably already picked up on. More on that in a minute.

In the fall of 2008, the following article was in the Washington Post:

Non-Nuclear Warhead Urged for Trident Missile

By Walter Pincus
Washington Post
Saturday, August 16, 2008

"A National Research Council blue-ribbon panel of defense experts is recommending development and testing of a conventional warhead for submarine-launched intercontinental Trident missiles to give the president an alternative to using nuclear weapons for a prompt strike anywhere in the world.

In critical situations, such an immediate global strike weapon "would eliminate the dilemma of having to choose between responding to a sudden threat either by using nuclear weapons or by not responding at all," the panel said in a final report requested by Congress in early 2007 and released yesterday."

This report to Congress was looking at this rapid response problem and Congress's concerns articulated in the next paragraph:

"Congress has delayed funding the conventional Trident program for two years while providing more than $200 million for research and development of additional, longer-term concepts for quick global strikes. One major congressional concern was that to other countries, such as Russia or China, the launch of a conventional Trident missile could not be distinguished from a nuclear one and could be mistaken for the start of a nuclear war."

Yup - that seems like a doozy of a problem to old Pliny. But the panel was nonplussed.

"The panel recognized that problem (that would be the Russia seeing the launch, and starting a nuclear war problem) and suggested several ways to mitigate it, but in the end it concluded that the benefits outweighed the risks. The panel said that before any deployment takes place, there should be diplomatic discussions, particularly with partner countries. It said these talks should include "the doctrine for its use, immediate notifying of launches against countries, and installing devices (such as monitoring systems) to increase confidence that conventional warheads had not been replaced by nuclear ones."

The panel also said that few countries, other than Russia and perhaps China, would be able to detect a sub-launched missile "in the next five years," and that because of the few warheads that would be involved, "the risk of the observing nation's launching a nuclear retaliatory attack is very low."

Benefits outweighing the risk? Hmm. Seems a bit like the old Pascal's Wager issue where the risk of being wrong is well - nuclear obliteration. I don't know about you but the benefits would have to be pretty amazing for me to feel good about this one.

"In its study, the panel focused on scenarios in which it said the Defense Department in the past "seriously contemplated strikes." These involved the need for an immediate conventional strike to preempt an adversary whose missile system was poised to launch a nuclear weapon at the United States or an ally; a gathering of terrorist leaders; a shipment of weapons of mass destruction during a moment when it could be hit; and an opportunity when an opponent's command and control capability could be struck before broader combat operations began."

The panel also adopted the Defense Department's idea that the goal of having one-hour capability for execution of a strike anywhere in the world is "sensible." It noted that in the 1990s, several attempts to kill Osama bin Laden or other al-Qaeda leaders failed because weapons systems available then, such as sub-launched cruise missiles, were not fast enough."

Again that sounds all well and good until you factor in the risk of nuclear war. Call me madcap but I'd rather let that murderous bastard Ben Laden go free a while longer rather than risking the USA turning into a burned out cinder. I guess I'm not patriotic enough or something. This just seems like a pretty big gotcha to old Pliny. Particularly when we link this thread to the incident in 1995.

Near Miss or Media Event?

On January 25 1995, the world may have come as close to nuclear war as it had during the Cuban Missile Crisis and the wargames fiasco during Reagan's term. A Norwegian rocket launch, about which Russia had been notified, was detected and triggered an alert. Now some claim that the confusion was exaggerated while others are convinced that Boris Yeltsin's decision to ride this one out saved our country from obliteration. All that angst because of one missile launch. It's not like it suddenly shot up out of the Pacific headed for GUT knows where. DoH! Sorry, that's the scenario we are talking about. Who knows for sure, but is it worth the risk? Let's use some empathy here, you are the leader of a nuclear power, the US suddenly launches a sub based missile, that may traverse your territory. They may have called you a couple of minutes ago and told you not to worry. What would you do?

I once had a notion that every ten years or so, all the world leaders and a selection of influential people should trot off somewhere to witness an atmospheric nuclear weapons test. There'd be some issues of course with the fallout but in the long run it might be worth it. I think sometimes we get pretty glib about what it means if one 300 kt warhead detonates let alone the thousands we have. Seeing is believing. I know, we can't, but would it be a bad thing for our leaders to really understand what's at stake?

Is the plan dead? Hard for me to tell. It may well be but the fact remains that it was seriously considered at all. I doubt this is the only idea of this type being considered. Plus, I found this from GlobalSecurity.Net:

"The FY2008 budget requested $175.4 million. But the Conventional TRIDENT Modification (CTM) program was "cancelled" in FY08 Appropriations Bill and funding was realigned to a defense-wide account [0604165D8Z - Prompt Global Strike Program] to investigate all prompt global strike alternatives and technologies."

??? Does that mean it's gone or just under a new name? A rose by any other name would smell as sweet but take care to remember that cow dung relabelled is the same..

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Contest Announcement!

My sense of humor is a burden at times. Be that as it may, I am starting a new contest. The contest rules are simple - Have some fun and twist one of the most beloved and pure icons of childhood innocence - i.e., name the best new color for a crayon! Or idea for a boxed set. The contest will run for 30 days and you may submit as many as you can muster. I will post a poll widget with the best submissions so that votes can be cast. To start things off, here's a nostalgic little number that I came up with...

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Or how about this gift set that might appeal to a special homeschooler living 50 miles north of Coeur d'Alene...


Let the games begin!

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With Compliments to Stacy's Jamaican Jade, this rendition of her entry has been created. Good early effort.

















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Once again showing how real life is often more absurd than fantasy, Crayola themselves have an entry that I think deserves consideration. Their website says of this "Multicultural Pack";

Children love to draw people. Crayola Multicultural Crayons include an assortment of skin tones that come in just about all the colours that people do. Crayon colours are: black, sepia, peach, apricot, white, tan, mahogany, and burnt sienna.

Yes children do, but looking at the pure white crayon I can't help but think that kids rarely draw people lacking any skin tone at all...
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Pliny has his own ideas about multicultural crayons. Here's some examples...














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Here technicians replace lemon yellow with Seeker's Yellow cake in boxes bound for Bagdad.

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The Eight-Squared Ode

Come see how they align, in perfect registry, soon to sacrifice themselves to a child's mediocre artistry;

Remember how each sans color was a perfect match, for every other in the batch; each clothed neatly in unspoiled paper and each tip immaculate with identical taper;

All those floor seats supporting more pedestrian chromic alchemy, while the exotic hues smugly wait above in that heavenly balcony;

Young and scion of one who toiled long coming home weary to the core, I was denied this visual feast and had to make due with only the 24; From no box seats would my colors descend, lest I begged to borrow Azure from a wealthier friend; Years later when grown and no longer poor, I went out and splurged and bought the 64.

Oh how the 64 reflected the breath of our society's reach, such as when MLK got flesh renamed peach. For some reason teachers thought Prussian Blue was not right, so thereafter it changed to permanent midnight. And who can forget ol' Indian red, a victim of misunderstanding that lead to chestnut in its stead;

Long was the anguish that my future wife did suffer from that fateful trip, when at 9 that fall severed each and every brand new tip. Even today that is the part she can recall, far more than the details of skinned knees from the fall;

And yes, today inflation has added 56 more, but in my memories 120 will never match the magic of the 64...