tag:blogger.com,1999:blog-83246008725232132282024-02-07T22:01:46.409-08:00AnxiolysisChallenging Fear in SocietyMichael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.comBlogger29125tag:blogger.com,1999:blog-8324600872523213228.post-80585513888658233942016-12-05T13:07:00.000-08:002016-12-05T13:20:43.067-08:00Fire/Paramedic Model A Job Raid, Not a Solution in Ontario<div class="MsoNormal">
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In July ,2015 I <a href="http://www.huffingtonpost.ca/michael-kruse/fire-medics-will-fail-in-_b_7891754.html" target="_hplink">wrote </a> about the “fire-medic” model being proposed by the Ontario Professional Fire Fighters Association (OPFFA). In it, I detailed all the reasons I felt that that proposal lacked water and was an incendiary attack on the work of paramedics in Ontario. After overwhelming public and governmental backlash, the OPFFA offered up a different proposal: to use the existing Advanced Emergency Medical Care Assistant (AEMCA) certified paramedics that work for fire departments as their first responders, armed with the standard Primary Care Paramedic (PCP) tool kit. They would respond to all high acuity calls in their area and apply symptom relief as they and their medical director saw necessary. This post is an attempt to respond to this change in the plan.<o:p></o:p></div>
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While this is a model that works in other jurisdictions where the fire department runs both the fire and rescue, and the pre-hospital medical programs, in Ontario we committed almost 50 years ago to separate fire and emergency medical systems. Fire regulated under the jurisdiction of the Ministry of Community Safety and Correctional Services, and Medics under the Ministry of Health and Long Term Care (MoHLTC). Fire Fighters were looped into the pre-hospital care model in the mid 1990’s when early automatic external defibrillators and CPR became the standard of care and we did not have investment in ambulance services that we needed to ensure fast enough response times. <o:p></o:p></div>
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Over the past 16 years, since ambulance and paramedic services were downloaded to the upper tier municipalities from the province, there has been heavy investment in paramedic care. The province picks up half the cost for PCP services (Advanced Care Paramedic services are the responsibility of the municipality) and the municipalities have responded to the response time standards set by the MoHLTC well, with the urban services served by the OPFFA hitting most of the targets most of the time. The ambulance and paramedic services negotiate with their local fire departments (FD) to determine what is called a “tiered response agreement”. This determines when FD resource is dispatched to a medical call. Some jurisdictions do not have these agreements, and the rules that govern these agreements can vary from jurisdiction to jurisdiction.<o:p></o:p></div>
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So currently, the response to pre-hospital emergencies in Ontario is governed by political pressures (response times), evidence-based medical priorities (the chain of survival), and legacy agreements that determine who “owns the call” when an emergency occurs in your community. This is a complex system, that has been made more difficult recently through the actions of the OPFFA and their leadership.<o:p></o:p></div>
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In a <a href="http://www.cbc.ca/news/canada/windsor/paramedics-fire-fighters-response-times-1.3867522">recent publicity video put out by the OPFFA</a>, they claimed that “EMS has problems, and fire fighters solve problems.” They cite increasing workload and missing response time targets as a problem that fire can fix. The problem with their argument is that there is no problem. <o:p></o:p></div>
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The Canadian Triage & Acuity Scale (CTAS) is the way that we assign a priority to medical emergencies. A ‘1’ is the highest (e.g. cardiac arrest) and a 5 is the lowest (e.g. a stubbed toe). The OPFFA appears to be using the provincial average response time for CTAS 1 and CTAS 2 calls, but these numbers are going to be different once we separate urban from rural systems. It is difficult to have a high density in rural EMS systems due to cost, so these times are going to be longer. As well, many rural services are served by volunteer fire fighters and not by OPFFA members, so no matter what the OPFFA does, the rural numbers will not be improved. <o:p></o:p></div>
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The urban services are meeting or exceeding their targets. For CTAS 1 we have to get there within 8 minutes about 60-70% of the time, and we do. Many services have deployed Paramedic Response Units to get a PCP to the scene even quicker. Yes, we could always do better, but the real question is do faster times mean better outcomes?<o:p></o:p></div>
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For the most severe of out-of-hospital medical emergencies, the cardiac arrest, most of the data shows much <a href="http://circ.ahajournals.org/content/early/2016/11/22/CIRCULATIONAHA.116.024400" target="_hplink">better survival with initiation of CPR and defibrillation within 5 minutes</a>. After the 5-minute mark, survival declines rapidly. This is why we send FD to these calls, but even they do not get there within the 5-minute mark on average. Their target is set by each municipality, but in most urban services transport times varying between 4-5 minutes. However, their reporting does not include the delays during dispatch or getting the truck on the road (called the turnout time, or what EMS calls the chute time). The total dispatch time can vary between 2-3 minutes. Adding this to the transport time the actual arrival time of the FD is between 6-8 minutes.<o:p></o:p></div>
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Ambulance transport times are recorded differently, with the clock starting once dispatch gets the call. This is a patient centred approach that sees the total response time from the time that you call to help to the time that EMS arrives on scene. These times vary, and you can see the most recent reported averages from my previous post. Suffice it to say, with a 6-8 minute fire arrival, and a 8-10 minute EMS arrival, we are arriving within a few minutes of each other, and neither of us are getting there within 5 minutes. Unless fire has secret plan to reduce this response time, they are not fixing that problem.<o:p></o:p></div>
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Let’s be clear, this is the required time to respond to a cardiac arrest. There is very little reporting on the impact that response time has for all other less-severe but still emergency medical conditions. In fact, there is no evidence that our response times matter at all in conditions other than cardiac arrest or conditions like choking that lead to cardiac arrest. <a href="http://emj.bmj.com/content/33/9/e9.1.short?rss=1" target="_hplink">Cannon et al 2016</a> found no change in 90-day mortality in response times for a fall in an elderly person. <a href="https://www.ncbi.nlm.nih.gov/pubmed/15995089" target="_hplink">Pons et al 2005</a> found that the 8-minute standard made no difference in patient outcome regardless of severity of illness, and for those who were at high risk to degrade you had to get there in 4 minutes or it made no difference. <o:p></o:p></div>
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Contrary to the <a href="https://www.linkedin.com/pulse/public-response-ctvs-w5-jeffrey-bilyk" target="_hplink">ridiculous reporting by CTV’s W5</a> a couple of months ago, very few of the medicines that all paramedics carry are curative. Nitroglycerin and ASA for cardiac chest pain does not cure the heart attack: transport to a cardiac centre and/or a surgeon does. Most paramedics in Ontario can read and interpret 12-lead ECG’s, a diagnostic test that allows us to rule-in a life-threatening heart attack and divert to a cardiac care centre, and all services in Ontario are on their way to meeting this standard. <o:p></o:p></div>
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Moreover, there are critical time windows that EMS is expected to meet for heart attack or stroke patients to go to the most appropriate facility. However, these times -- the “door to needle” time for heart attacks, or the stroke bypass time -- are a matter of hours, not minutes; a trauma alert has a standard of the “golden hour”. The OPFFA is arguing that getting there quicker is what saves lives. While this may be true for cardiac arrest, to make a difference in most high acuity calls we have to get a transporting ambulance there sooner, which means we need to invest in ambulances, not in putting mileage on fire trucks. <o:p></o:p></div>
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However, our response times are driven by public distress: when you call 911, you want someone there quickly, no matter what the problem. I understand that, but how much are you willing to spend to reduce these already fast times by a few minutes? <a href="http://emj.bmj.com/content/early/2010/08/25/emj.2009.086363.abstract;" target="_hplink">A study conducted in the UK</a> found that to reduce the response time in England and Wales by one minute it would cost £54 million. In Ontario, with much less population concentration, this would cost a lot more than the equivalent $20 million (CAN). And to reduce our average down to the supposed gold standard of 8 minutes it would be multiples of that amount. To get this response time to 5 minutes for cardiac arrest would be a challenge for fire as well. Heck, we could place a “beat medic” on every street corner and reduce the response time to a few minutes. Where do we draw the line?<o:p></o:p></div>
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Given the quickly diminishing returns as we spend more and more money to reduce response times, we need to use evidence as our guide for getting the right resource to the right patient at the right time. I went over the numbers for the fire/medic proposal in <a href="http://www.huffingtonpost.ca/michael-kruse/fire-medics-will-fail-in-_b_7891754.html" target="_hplink">my last post</a>, but even though that proposal has been withdrawn the economics are the same. <o:p></o:p></div>
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The major cost was not training and equipping the fire/medic, it was the unreported costs in doubling mileage, overnight rest incursion, sick time and the dangers to the patient when rushing to a diagnosis and treatment. Rob Hyndman, the OPFFA president, stated in a recent interview that the FD is already attending these calls, why not allow the medics on board to practice in their full scope? I would argue that this is jurisdiction dependent. The FD does not currently go to all emergency medical calls in their area and the calls they do attend are dependent upon the tiered response agreement. <o:p></o:p></div>
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Therefore, for the medics on the fire truck to practice their full scope, this would mean increased call volume and all of the human and economic problems I outlined in my last post. It just does not make sense to send 5 people in a million-dollar apparatus to get 1 person to the scene 2-3 minutes before a transport ambulance. Any medic who is coming to a decision to treat with drugs in 2-3 minutes is not taking care to make sure they are doing the right thing. This is still not a good plan.<o:p></o:p></div>
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One last note. If the OPFFA was as concerned for public safety as they were for protecting the diminishing need for fire responses they would be doing everything they can, as EMS does, to train the public to the minimum CPR standards and make public access defibrillators available. This is the real key to survivability in out-of-hospital cardiac arrest.<a href="http://www.auditor.on.ca/en/content/annualreports/arreports/en15/4.04en15.pdf" target="_hplink"> Recently</a>, EMS dispatch in Ontario has identified all of the public access defibrillators so they can give instructions to callers, and there has been much hype in <a href="https://www.ncbi.nlm.nih.gov/pubmed/27729058" target="_hplink">drone delivered AED’s</a> in the community. But bystander CPR, by far, is the biggest improvement we can make in survivability from cardiac arrest. We need to train the public and identify emergencies near them so we can bridge to a timely defibrillation, and most urban EMS services in Ontario are active in public-access defib and CPR training in the community.<o:p></o:p></div>
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This push by the fire union into medical intervention is not a turf war, it is a raid. EMS in Ontario has been growing to meet the challenges of an aging population that relies more heavily on paramedic care to keep them well and get them to the hospital safely, and despite the growing number of calls, we have meeting provincial targets or decreasing our response times in the urban centres that the OPFFA services. The fires service in my own backyard has been actively recruiting paramedics to work on their vehicles and is already training to implement this system. While EMS has been growing, the OPFFA has been eyeing our work as theirs declines to save jobs: this is a workplace raid, and nothing less.<o:p></o:p></div>
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At the same time, the OPFFA constitution says that if you choose, as a fire fighter, to work in your home community as a volunteer fire fighter, you will be expelled from the union. So, the fire fighter union, which is purporting to have the public’s welfare in mind, is expelling so-called “double-hatters” from their ranks at the same time they are promoting the roles of fire/medic “double hatters” in the urban services. I guess the OPFFA can ignore their constitution when it suits them.<o:p></o:p></div>
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It must be difficult as a Fire Chief or OPFFA executive, to go to conferences in the US and sit with their colleagues and try to explain the EMS system in Ontario. “What do you mean, you guys don’t have medics on the fire trucks? What have you been doing for the last 50 years!?” must cut to the bone and make it seem like FDs in Ontario have been made second class citizens of emergency services. Pride is no reason to throw more money at a problem that doesn’t exist. <o:p></o:p></div>
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EMS chiefs and upper-tier municipalities know they have challenges to meet with a growing demand for paramedic services, but we need to understand what levers to pull to make it better, not just pulling the easy levers and hoping the problem will go away. Offload delay is not a problem of response times, it is a problem of too few beds in the ER to accept patients; it is a problem of too few beds in the hospital to accept admissions from the ER; it is a problem of too few long-term-care (LTC) beds in the community to accept patients from the hospital; it is a problem of frighteningly high patient-to-nurse ratios at LTC facilities that lead to patients needing to go to hospital; it is a problem of a lack of family physicians in the community so people turn to the ER and ambulance for care; it is a problem with a broken and underfunded Community Care Access Centre system that leaves vulnerable citizens without the care they need to stay at home. None of these problems are addressed in the OPFFA plan because the real problem they are trying to fix is the decreasing number of fire calls and subsequent lack of things to do.<o:p></o:p></div>
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Finally, a <a href="https://www.amo.on.ca/AMO-PDFs/Reports/2016/ExpandingMedicalResponsesDiscussionPaperMOHLTCNov2.aspx" target="_hplink">recent MoHLTC letter</a> reiterated that the MoHLTC has jurisdiction over this decision, and that any change to the ambulance act that would be needed to allow for PCPs to operate on fire trucks would have to be based on evidence. The OPFFA has provided no evidence that expanding the scope of fire fighters will in any way affect the outcome of a medical emergency in their community. They insist that their work will lesson the burden on EMS but they don’t say how, and neither does the evidence. Delaying transport to save money keeps the patient away from hospital for longer and will increase risk. What is clear is that without evidence, the OPFFA’s raid on EMS work is nothing but a puff of smoke.</div>
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Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com7tag:blogger.com,1999:blog-8324600872523213228.post-71106678353053871772010-01-17T09:43:00.000-08:002010-01-17T10:18:09.921-08:00Haiti Hoax'ersGiven the scale of the destruction and misery in Haiti caused by the earthquake this week, it is not surprising that many people have been moved and motivated to give money or goods to help the people affected. It is also not surprising that with money flying about as freely and unselfishly as it is that someone is going to find a way to get in the way of that money and the people who need it; or at the very least set up some malicious and thoughtless roadblocks.<br /><br />The easiest way to spread these malicious memes is through social media. Facebook, Myspace, Twitter etc., move very quickly and when people find an idea that motivates peoples emotions it is really easy to spread misinformation and myths. One of the bigger ones this year was the election of a <a href="http://www.techcrunch.com/2008/01/09/french-press-falls-for-major-facebook-prank/">"facebook president"</a> that the French press bought hook line and sinker. Social Media is perfect for the dissemination of gossip and lies, so we must all remain skeptical when someone asks us for money.<br /><br />I have seen several dubious claims of money donation of facebook this week. They all are a vaiation of "pass this message on and I will donate X to haiti". One FB <a href="http://www.facebook.com/search/?q=haiti&init=quick#/pages/Jeder-Fan-bedeutet-eine-Kerze-fur-die-Opfer-in-Haiti-Mach-mit/268652076968?v=wall&ref=search">group </a>claimed that they would donate $1 for every fan that joined <a href="http://www.facebook.com/search/?q=haiti&init=quick#/group.php?v=wall&ref=search&gid=290862327714">another </a>25 cents- I suspect no donation will be passed on.<br /><br /><a href="http://www.snopes.com/inboxer/charity/haiti.asp">Scopes.com</a> has a great page that is accumulating hoaxes surrounding the Haiti disaster and fund raising. When making a choice to donate, I would suggest finding the company with the greatest throughput of your money to the people they say they are representing. <a href=":%20http://www.forbes.com/2004/11/23/04charityland.html">This </a>is a list of those who have been deemed the most efficient in expenses and fundraising as per Forbes magazine. And <a href="http://www.forbes.com/2010/01/13/haiti-earthquake-charities-personal-finance-spotting-scams.html">this</a> is another article in Forbes on how to spot dubious charities.<br /><br />I think you cant go wrong with <a href="http://www.doctorswithoutborders.org/">Doctors without Borders</a> and the <a href="http://www.redcross.ca/article.asp?id=000005&tid=003">Canadian Red Cross</a>. Stay away from anyone, especially an anonymous private citizen or facebooker who is claiming to give money if you do so-and-so : it is usually a hoax.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com1tag:blogger.com,1999:blog-8324600872523213228.post-39735652800046167502009-11-17T20:13:00.000-08:002009-11-19T00:09:30.703-08:00Toward a Scientific EducationI have had the rare joy to interact with my friend's young daughter as an avuncular "science guy". Whenever I come over, the first question is "are we going to do science today?" Her vision of science, so far, is a modest one, limited to <a href="http://scifun.chem.wisc.edu/HomeExpts/HOMEEXPTS.HTML">chemical tricks</a> - she could spend hours with a package of <a href="http://www.escience.ca/genSci/RENDER/6/1030/1067/12751.html">pH test strips</a> - but she is engaged, and that is what counts. I am left wondering, however, about at what point this fascination with the world of science will be challenged by other things, and how school and society will equip her with the tools to properly evaluate claims and come to rational decisions.<br /><br /><span style="font-weight: bold;">Background</span><br /><br />The public has been challenged a great deal lately to decide among competing claims of fact and fiction. The <a href="http://www.phac-aspc.gc.ca/alert-alerte/h1n1/fs-fr_h1n1-eng.php">H1N1 crisis</a>, Ray Comfort and his creationist <a rel="nofollow" href="http://www.youtube.com/watch?v=2z-OLG0KyR4">banana</a>, even the end of the world myth of <a href="http://www.nasa.gov/topics/earth/features/2012.html">2012 </a>have stirred a great many people to question science and established facts. Few of us non-scientists have the <a href="http://www.skepticstoolbox.org/">tools </a>necessary to weigh the arguments, we just want to protect ourselves and our family and live a healthy and <a rel="nofollow" href="http://legendsofbeer.wordpress.com/2008/12/14/10-greatest-beer-tv-commercials/">prosperous</a> life. Most of the time, we "go with our gut" and let fear of the unknown be our guide. How far will that get us in the future? How far is that getting us now?<br /><br /><span style="font-weight: bold;">Facts vs. Process</span><br /><br />We know more now than we ever have about how the world works and these facts have to be imparted upon and absorbed by students before they are to enter any type of specialisation in post-secondary school. The current high school <a href="http://www.edu.gov.on.ca/eng/curriculum/secondary/science.html">curriculum</a> in Ontario, shortened several years ago to 4 years, has much more information packed into it and is very fact-dense. Quantum mechanical models of chemistry are introduced in grade 11, genetics and gene regulation are discussed in depth in grade 12 biology (nowhere is evolution itself mandated; the biology curriculum seems to dance around it over 3 years.) With all of this raw information to impart, where does the actual job of "doing" science fit in?<br /><br />It must take a great effort to distill the current consensus knowledge into appropriate chunks that can be understood by the average high-schooler. Anderson and Sharma point out that "scientists 'do' science and students 'learn' science" and this distinction is an important one (2007). The laboratory work mandated in high school and even in first year university biology, chemistry and physics is geared toward understanding the concepts and applying the knowledge, not discovering new things. There is an expected output from an experiment. What if you get it wrong? In high school I was frustrated when it did not work out the way it was supposed to. Sorting through the data was not clean and if you had any confounding factors like measurement errors, or broken equipment, the concept got lost among the data and science became just a bit more incomprehensible.<br /><br />The science of discovery does not work like it does in the text books. The path to new ideas is not a well-ordered and sequential one: it is <a href="http://dsc.discovery.com/fansites/mythbusters/mythbusters.html">messy</a>. It meanders from bad idea to bad idea until some anomaly pops up and takes you in a new and productive direction. When tasked to apply the scientific method to a study of worms, one grade 9 class studied by <span style="font-size:100%;">Xiaowei et </span>al (2008) found a conflict between the ordered list given them, and the task at hand. Only when they were allowed to brainstorm and take an "anything goes" approach to the process, did new ideas come up and the exercise made a bit more sense.<br /><br />I propose that science class, the place where you would think that critical thinking and rational logical thought would be taught, is the last place it is being taught, and indeed, the last place it can or should be taught.<br /><br />We need a new paradigm.<br /><br /><span style="font-weight: bold;">Critical Thinking and Scientific Reasoning: Required To Graduate</span><br /><br />I recently was going over <a onclick="'s_objectID=" author="Greg+Craven_1" href="http://www.chapters.indigo.ca/used-books/getSearchResults?author=Greg+Craven"></a><a href="http://www.gregcraven.org/">Greg Craven</a>'s <a href="http://www.youtube.com/watch?v=AE6Kdo1AQmY">The Most Terrifying Video You'll Ever See</a> and his <a href="http://www.amazon.ca/Whats-Worst-That-Could-Happen/dp/0399535012/ref=sr_1_1?ie=UTF8&s=books&qid=1258616801&sr=8-1">approach </a>to decision making and it struck me that since high school is meant to prepare students for life after high school, perhaps there something missing from the current curriculum. In Ontario we have three streams: university prep, college prep, and workforce prep. All three areas require you to think critically; heck, choosing the right doctor, choosing the right food and even choosing whether to try that <a href="http://www.funny-games.biz/videos/659-firemelon.html">stupid stunt</a> all require critical thinking. A good citizen needs to be able to evaluate the claims of their leaders, from the local health authority to the prime minister. De La Beche, the English geologist who started the first school of mines decided to bring scholarly learning to the people with the intent that they "should have the power to discriminate between sound and unsound views" using the existing knowledge (Clary, Wandersee, 2008.) Is this such a lofty goal that it is unattainable by our youth?<br /><br />The high school curriculum is packed to the gills these days, but we do have to prioritise. I propose a senior level course in critical thinking and rational thought that is a requirement to graduate. It would have several strands including <a href="http://en.wikipedia.org/wiki/Logic">logical reasoning</a>, <a href="http://www.robertniles.com/stats/">basic statistics</a>, and research and <a href="http://www.library.cornell.edu/olinuris/ref/research/skill26.htm">source evaluation</a>. I would also suggest that it also include a research component in which the student had to design and implement their own mini-study. The messiness of scientific inquiry should be the focus here, with an emphasis on identifying all of the variables if not trying to control for most of them.<br /><br />Something, anything, would be good.<br /><br /><span style="font-weight: bold;">Conclusion</span><br /><br />I had the comical pleasure of seeing 2012 yesterday evening and I was struck by the similarity of the main story line to the story told by Young-Earth Creationists when addressing the biblical flood. The reasoning is strikingly similar: an expansion of the mantle bursts through the crust expanding the sea floor, causing sea levels to rise and flood the continents (Heaton, 2008). The difference, of course, is the movie is a work of obvious fiction, but the YEC's tart up their confabulations and conjecture in a language that is unique to scientific publishing. Not a <a href="http://www.elsewhere.org/pomo/">post-modern</a> approach per se, but a scientific parlance <a href="http://www.fzu.cz/%7Esipr/documents/science_language.html"></a>that has developed as a <a href="http://www.fzu.cz/%7Esipr/documents/science_language.html">short hand</a> to communicate with other scientists (Sharma, Anderson, 2007). Take out the references to the bible and the discourse by the YEC's would be nearly indistinguishable from mainstream science, if you had nothing but grade 10 science education to judge it by. To guard against this we need to teach facts, yes, but one person cannot know all of the facts. We need a way of evaluating ideas without relying on our own knowledge of facts, lest we fall prey to more insidious ruminations and conjecture.<br /><br />I am not sure where to go with this; I am not a science teacher, nor do I know any trustees. I had the displeasure of noticing in the Toronto School Board's <a rel="nofollow" href="http://econnect.tdsb.on.ca/econnect/Activities/Activities.asp?SCheck=510648838&SDT=40136.1231828704&SectionId=2&SubSectionId=14">Learn4Life </a>booklet this fall that I have many options if I want to learn alt health practises like "manifesting" or reiki. Perhaps I will start to lobby for some courses on critical thinking. We have to start somewhere: before the mantle of pseudo-science rises and threatens to overwhelm us all with a flood of bad ideas.<br /><br /><span style="font-size:85%;"><br /><span style="font-weight: bold;">REFERENCES</span><br /></span><br /><span style="font-size:78%;">Bolte, C. 2008. A Conceptual Framework for the Enhancement of Popularity and Relevance of Science Education for Scientific Literacy, based on Stakeholders' Views by Means of a Curricular Delph Study in Chemistry. Science Education International. Vol 19, No. 3, September 2009, pp331-350.<br /></span><span style="font-size:78%;"><br />Clary, R. M., Wandersee, J. H. 2008. All are Worthy to Know the Earth: Henry De la Beche and the Origin of geological Literacy. Springer Science+Business Media B.V. </span><span style="font-size:78%;">[Internet]. [cited 2009 Nov 18].</span><span style="font-size:78%;"> Sci & Educ (2009) 18:1359-1375.<br /></span><br /><span style="font-size:78%;">Heaton, T. 2008. Recent Developments in Young-Earth Creationist Geology. Springer Science+Business Media B.V. [Internet]. [cited 2009 Nov 18]. Sci & Educ (2009) 18:1341-1348.<br /></span><span style="font-size:78%;"><br />Sharma, A., Anderson, C. 2007. Recontextualization of Science from Lab to School: Implications for Science Literacy. </span><span style="font-size:78%;">Springer Science+Business Media B.V. </span><span style="font-size:78%;">[Internet]. [cited 2009 Nov 18]</span>. <span style="font-size:78%;">Sci & Educ (2009) 18:1359-1375.<br /><br /></span><span style="font-size:78%;">Xiaowei, T et al. 2008. The Scientific Method and Scientific Inquiry: Tensions in Teaching and Learning. Wiley Periodicals, Inc [Internet]. [cited 2009 Nov 18]. Learning 10.1002/sce.20366.<br /></span>Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com2tag:blogger.com,1999:blog-8324600872523213228.post-4407448971190871652009-10-13T07:18:00.000-07:002009-10-13T08:07:24.012-07:00Cognitive Dissonance in Laramie, WyomingOn the evening of Oct 6, 1998, <a href="http://en.wikipedia.org/wiki/Matthew_Shepard">Matthew Shepard</a> was approached by two men, Aaron McKinney and Russell Henderson, at the Fireside Bar in Laramie, Wyoming. These men enticed Matthew into McKinney's pick-up truck, drove him to the outskirts of town, tied Matthew to a fence, pistol-whipped him and left him to die, which he graciously did on Oct 12, 1998 in a Poudre Valley Hospital bed in Fort Collins, Colorado.<br /><br />I was the Lighting Designer for the <a href="http://www.studio180.ca/pastproductions/the-laramie-project">Canadian premier</a> of <a href="http://community.laramieproject.org/">The Laramie Project</a>, in Toronto in 2003. A play written by the <a href="http://www.tectonictheaterproject.org/">Tectonic Theatre Company</a> from New York City, The Laramie Project describes the events surrounding the death of Matthew Shepard, and is based on transcribed interviews of the townspeople of Laramie and the surrounding county.<br /><br />It was an honour to revisit the play through the epilogue to the story: <a href="http://www.tectonictheaterproject.org/Tectonic.html">Laramie: Ten Years Later</a>, where the members of Tectonic Theatre Company returned to Wyoming and spoke to those they had interviewed earlier to find out what changes, if any, had occurred in the ten years since the death of Matthew and the conviction of his murderers. An unsettling trend started to emerge.<br /><br />It seemed that the original facts of the case, which had led investigators to conclude that what had started as a robbery later turned into a homophobic beating of a gay man, had been twisted, or outright forgotten, by many members of the community. The story by many not connected personally to the case was that the attack was nothing more than a drug trip gone bad, and was only a robbery. They said that the hate-crime label that had been attached to the case was a work of fiction and had been blown out of proportion by the media, and that the victim's homosexuality was a peripheral matter and not important to the case.<br /><br />Needless to say, the members of Tectonic were a bit stunned by this assertion, and dug deeper to find the roots of it.<br /><br />It turns out that in 2004, the ABC series 20/20 had aired a <a href="http://abcnews.go.com/2020/Story?id=277685&page=1">report </a>that offered "new evidence" that what was largely reported by police as a hate-crime was a robbery gone wrong, and fueled by crystal meth. They insisted that the gay bashing had been hype by the defendants to try to pin the murder on a backlash against gay advances, and that the original and only motive on the night of the murder had been robbery and drugs. In fact, they insisted, McKinney was flying high on meth and had been on a drug-rage when he beat Shepard.<br /><br />Unfortunately for ABC, these assertions are patently false and based on hearsay, revised testimony, conjecture, and rumor, and fly in the face of original statements made by McKinney and other witnesses. More importantly, they directly conflict with the confessions offered during the trial. A very good refutation of the 20/20 report was written by AaronParsely for the NYU School of Journalism's <a href="http://journalism.nyu.edu/pubzone/recount/article/95/">Recount Magazine</a>. The 20/20 account can be easily refuted by reading the original court transcripts and police reports, which found no drugs in the system of McKinney or Henderson that night. So why did this story start to supplant the facts of the case?<br /><br />Laramie, Wyoming was deluged with reporters after the death of Matthew Shepard and throughout the trial of McKinney and Henderson. The "gay-panic" defence that was offered by the defendants fed the fire of fear for homophobia in this "red-neck" town. The townspeople were in no way united in this feeling, and though Tectonic and others found those who blamed Shepard for the crime and showed open homophobia, this was not the mainstream. Those interviewed felt the need instead to promote their agreement with the "live-and-let-live" doctrine. <br /><br />In Tectonic's revisitation to Laramie, 10 years later, it was evident that many residents, especially those not involved in the original case, had begun to re-write history. They were aided by the misinformation spread by ABC, who did interview many of the same people Tectonic did, but whose voices were stunted and distorted by editors and the 30-second sound bite. The shame that the state and the city of 27000 feel seems to be at the root of this revision. The cognitive dissonance supplied by the label the <a href="http://reason.com/archives/1999/05/01/the-hate-state-myth">"hate-state"</a> , has made people actively forget or discount sworn testimony in court, and supplant the facts with their own sanitised myth. No-one wants to be known for a hateful and brutal crime, and Laramie had become a mecca for many who were touched by Shepard's killing. The fence was taken down and there were complaints to the local paper, <a href="http://www.laramieboomerang.com/">The Laramie Boomerang</a>, about its coverage of the anniversary. Many people told Tectonic that they "...just wanted to put this behind them." This meant, in many cases, sanitising the death of Matthew Shepard and blaming it solely on the easy mark of drugs and robbery.<br /><br />After the reading of Laramie: Ten Years Later, last night, there was a live webcast of a Q and A from the Lincoln Centre where Tectonic Theatre Company performed their version of the play. A large point made at the gathering was that hate-motivated crimes against the gay community were, by no means, the exclusive property of Laramie, or Wyoming, the mid-western U.S, red-necks or young men on drug benders. No: the crimes occur everywhere. On the eve of last night's event a gay man was <a href="http://www.nydailynews.com/news/ny_crime/2009/10/12/2009-10-12_gay_man_gets_brutal_beating.html">targeted </a>and beaten in Queens, New York, and currently clings to life in hospital. During the second run of The Laramie Project in Toronto back in 2004, a gay man was <a href="http://archives.xtra.ca/Story.aspx?s=15051640">attacked </a>by a 20 year old straight man in a gay bar in Hamilton and his face was cut up terribly by a broken beer bottle. Laramie, by no means, owns this problem exclusively.<br /><br />It was an ugly crime, the killing of Matthew Shepard. One that many would like to forget and certainly not one that a town like Laramie would like to gain notoriety from. Like those who try to deny the Holocaust, the revision of Laramie's history is an attempt to protect themselves from the horror and their complicity in the hate that contributed to the crime. The facts still stand, however, and those who spread rumor and conjecture must be challenged.<br /><br />When asked about the international relevance that The Laramie Project had, Moises Kaufman, the director of Tectonic Theatre recounted a meeting he had with one of the participants in the play's production in Berlin, Germany. When asked how the play was received there the man said:<br /><br />"Laramie: It is just like my town."Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com2tag:blogger.com,1999:blog-8324600872523213228.post-74015825382423892982009-10-09T07:44:00.001-07:002009-10-09T08:00:38.401-07:00Citizen ScienceIncluding the public in scientific endeavours is a great way to get the public excited by science and education them. I took several moments to identify <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">craters</span> on the mars several years ago through the <a href="http://clickworkers.arc.nasa.gov/"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">Clickerworkers</span> </a>site on <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Nasa</span>. The <a href="http://setiathome.berkeley.edu/"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">SETI</span> At Home</a> program, and other <a href="http://boinc.berkeley.edu/"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">BOINC</span></a> distributed computing projects are great ways of harnessing unused computer capacity and engage the public in these efforts. This week, I learned of two more projects that are very exciting and are a great way to pass the time while on break at work.<br /><br />The first is <a href="http://www.galaxyzoo.org/">Galaxy Zoo</a>. It is a project to categorize galaxies photographed by the <a href="http://www.sdss.org/">Sloan Digital Sky Survey</a> by using human beings instead of computers. Humans are much better at shape classification than computers and the <a href="http://www.galaxyzoo.org/team">Zookeepers </a>have published several papers already and are expanding galactic science with the help of the general public. And it is pretty fun too.<br /><br />The second project is more of a free scientific service being offered by <a href="http://www.aspexcorp.com/resources/send_sample.html"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">Aspex</span> </a>as they are trying to market their new desktop scanning electron microscope. You can fill out a form and send them a sample of anything you would like to be scan, and they will scan it and post your pictures.<br /><br />Nothing works better, I think, at engaging the public than including the public in scientific projects. These two ideas are great examples of this<br /><br />Now, I am going to scrape something off my floor and post it to <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Aspex</span> right away; that may give me the motivation to clean my apartment.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com4tag:blogger.com,1999:blog-8324600872523213228.post-37238111886851172172009-10-07T18:55:00.001-07:002009-10-07T18:55:41.973-07:00Digesting Science<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcU2Le14xbX6KBu9CCDLFjaCxYugphHMQnmlHm3paIfCwLRVzEygQ5uzDDl9EaIRptd5kFxu61oKYTQrxfp6MmsdA4wu0teOjHIBZEswFskfri0TF9DSfROAEqGu1lWBcPNqTzTsH7wd8/s1600-h/USDA_Food_Pyramid.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 250px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcU2Le14xbX6KBu9CCDLFjaCxYugphHMQnmlHm3paIfCwLRVzEygQ5uzDDl9EaIRptd5kFxu61oKYTQrxfp6MmsdA4wu0teOjHIBZEswFskfri0TF9DSfROAEqGu1lWBcPNqTzTsH7wd8/s320/USDA_Food_Pyramid.gif" alt="" id="BLOGGER_PHOTO_ID_5390040823182589458" border="0" /></a><br /><div>Food causes a lot of anxiety in most of us. Many people struggle with their weight and there has been a <a href="http://www.statcan.gc.ca/pub/82-620-m/2005001/article/adults-adultes/8060-eng.htm#2" target="_blank">doubling</a> of the rate of obesity in Canada since 1978, and the rates in the US are even <a href="http://www.cdc.gov/obesity/data/trends.html" target="_blank">worse</a>. It is no wonder that there are diets for every season and taste, and desperate people are easy to sell to; especially if they have tried and failed several times before.</div> <div> </div> <div>The US government is undertaking a <a href="http://www.cnpp.usda.gov/DietaryGuidelines.htm" target="_blank">review</a> of their food pyramid. This process is due to be finished in 2010 and the Centre for Nutrition Policy and Promotion is welcoming comments from any and all people - including the conspiratorially minded, of course! I waded into a bit of a <a href="http://www.sciscoop.com/dietary-advice-and-obesity.html#comment-7024" target="_blank">bun fight </a>at a science blog aggregation site <a href="http://www.sciscoop.org/" target="_blank">www.sciscoop.com</a>, this week with one David Brown, who was suggesting a supposed conspiracy by "big <span class="blsp-spelling-error" id="SPELLING_ERROR_0">agra</span>" to co-opt the research and promote the ingestion of grains, including corn, soybeans and the deadly "wheat" plant instead of healthier saturated fat, meat and dairy.<br /><br /><br />I had a discussion with another friend who feels sympathy with the skeptics movement but who felt like her knowledge of science was not large enough to debate someone who was making scientific assertions. In many, more technical, discussions this may indeed be the case. When I began to swim in the very deep and murky waters of nutrition science, I soon discovered that David Brown, the man I was arguing with, did have some points and it was easy to find many studies, like <a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1368980&tool=pmcentrez" target="_blank">this one</a>, that seemed to suggest that high-fat, low <span class="blsp-spelling-error" id="SPELLING_ERROR_1">carb</span> diets improved cardiovascular risk factors (although his <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">incessant</span> quoting of one nutritional text was a bit tedious, to say the least). However, the consensus in <a href="http://www.cochrane.org/reviews/en/ab002137.html">many more</a> papers was that low-fat diets were the recommended course for most people in avoiding atherosclerosis and eventual heart attack.<br /><br />Was was very clear was that nutrition science is a very complicated and constantly evolving science that I have neither the training nor the time in google university to even attempt to state a strong position on, beyond the consensus. This did not stop David Brown, however, and he made some very dubious claims. Ones that were mimicked by many people at such aloof centres of education as <a href="http://yahooanswers.com/" target="_blank">answers.yahoo.com</a> . Like <a href="http://ca.answers.yahoo.com/my/profile;_ylt=A0WTcZm048tKpzsB8gTnFwx.;_ylv=3?show=84821087cda14dd0bdf6bd3bbda14952aa">this guy</a>, for instance, who decided his doctor, with several years of medical training, "knew nothing" about nutrition, so he had to do his own "research" and tell us all about it. He has answered over 3000 questions spreading the bad word about vaccines and evil <span class="blsp-spelling-error" id="SPELLING_ERROR_3">pharma</span>, and I bet, like our pal <a href="http://www.stopjenny.com/">Jenny</a>, he has his own small body count.<br /><br />When answering my friend on her concerns over picking a skeptical fight, I told her that it has taken me a year to get my skeptical radar in order and be able to spot the fallacies at first glance that identify those with dubious reasoning skills and ideas instead of facts (and I am by no means at the peak of my performance). I continued to argue with David Brown and pick apart his faulty reasoning without having to know the complete ins and outs of <span class="blsp-spelling-error" id="SPELLING_ERROR_4">LDL</span> and <span class="blsp-spelling-error" id="SPELLING_ERROR_5">HDL</span> cholesterol and the effects of saturated fat intake on triglycerides.<br /><br />Of course, anyone searching for answers on Yahoo.com about, well anything other than knitting advice and stain removal, gets what they deserve, as the person answering the question gets to decide what the best answer is. Though the democratic fallacy behind this reasoning should be obvious to the wizards at yahoo, I guess it is just another attempt to sell advertising, instead of educate. I have noticed that we don't go and "yahoo" anything when we need to know a fact.<br /><br />The skeptical toolbox is a powerful one, and can give support to your argument while you search for facts to back up scientific claims. Unfortunately, there is a lot of woo to wade through in the search for truth, and 3000 wrong answers is a bit daunting.<br /><br />I am going to need some bigger hip waders, and perhaps a pontoon boat.<br /><br /><br />addendum<br /><br />In my search, I found more compelling arguments about the high fat, low <span class="blsp-spelling-error" id="SPELLING_ERROR_6">carb</span> diet, like <a href="http://www.cnpp.usda.gov/Publications/OtherProjects/SymposiumGreatNutritionDebateTranscript.txt">this debate</a> sponsored by the US Dept. of Agraculture. It was a debate between several of the fade diet doctors in 2000 and was quite compelling. Of course, it is not compelling enough to change the consensus, apparently, but it is an interesting debate, and highlights the grey area that nutrition inhabits and the ideologues it harbours. </div> <div> </div> <div><a href="http://www.cnpp.usda.gov/Publications/OtherProjects/SymposiumGreatNutritionDebateTranscript.txt" target="_blank"><br /></a></div>Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com2tag:blogger.com,1999:blog-8324600872523213228.post-63501494009787403342009-10-01T10:07:00.000-07:002009-10-01T10:11:36.434-07:00Canadian Skeptic BlogThe momentum gained from The Amazing Meeting 7, not to mention the new friends and connections made, has resulted in the first nation-wide Canadian skeptical blog, with contributors from across canada and from many different walks of life. I will be one of the regular contributors as well, which will be a great challenge, and I can hardly wait to get started.<br /><br />In the mean time, check out the blog for up-to-date postings concerning all matter of woo, pseudo-science, fear-mongering and chicanery; and not a wee bit of critical thinking on public health!<br /><br />http://www.skepticnorth.com/Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com1tag:blogger.com,1999:blog-8324600872523213228.post-65399558221318074492009-09-22T07:33:00.000-07:002009-09-22T08:26:24.994-07:00The Straight Dope about HomoeopathyThis week, the Georgia Straight published an <a href="http://www.straight.com/article-258247/homeopathy-offers-alternative-flu">article </a>by the daughter of the publisher of the paper espousing the benefits of homoeopathic remedies for the H1N1 influenza virus due to hit North America in full force this fall. After a round of pillory by the Canadian skeptics calling the author out on her assertions, the publishers included an <a href="http://www.straight.com/article-258584/medical-error-lot-more-dangerous-homeopathy">article</a> detailing a<a href="http://www.cmaj.ca/cgi/content/full/170/11/1678?ijkey=5f671e1e66594153404d3fa4d05050ab8b8d61bb"> new study</a> about the rate of medical errors in Canada in hospitals. While the 23000 deaths in 2000 attributed to medical errors is very disturbing, this defence of homoeopathy is one big red herring. Here is the comment I left on the article - which may or may not be published..we will see<br /><br />"The chance of making a medical error looms over every health professional's head. Especially when you are applying treatments that have large inherent risks, like surgery or anaesthesia. What this article does not address is the much larger number of Canadians who are helped by or cured by modern medicine - which surely numbers in the millions every year; let alone those whose lives are extended by drugs treating their chronic conditions.<br /><br />The way the medical and skeptical community raises its voice is by doing SCIENCE. To uncover problems in our therapies and interventions, publishing them so the public and our peers can see the problem, and then trying to abate it. When was the last study done by homoeopaths of this kind? I see you did not cite any study like this.<br /><br />The reason homoeopathy has no side effects is because it has no effects, outside the placebo effect. The danger in using homoeopathy to prevent the flu is that you are avoiding real treatment - and this will surely do some harm. We have already seen outbreaks of measles (a serious disease that can kill your child) in the US and the UK because of the lessoning of vaccination. The regular flu kills 36000 people in the US every year - and this is less virulent than the H1N1 strain.<br /><br />We have to lower the death-from-error rate, no doubt, but it surely sits below 1 percent now. Digging up this red herring of medical errors does not lesson the argument against homoeopathic flu medicine - it just muddies the waters some more and confuses the issue. The flu vaccine is safe and effective at preventing flu. Homoeopathic medicine is safe but not effective at preventing the flu. I know which one I will choose. <div style="float: right;" class="clearfix"> </div>" <br /><br /><br />The debate over the flu vaccine seems to be one of competing fears. The two major arguments are as follows:<br /><br />Medical Community:<br /><br />The H1N1 influenza virus is a novel virus for which we have no immunity. It is more virulent than the normal seasonal flu, if not more deadly. To prevent serious complications in target populations (young people, pregnant people, health care workers) you should get vaccinated.<br /><br />Vaccine-denial Community:<br /><br />The H1N1 influenza virus is not nearly as bad as the medical community says it is. It is just a ploy by big pharma to sell more vaccines. These vaccines have not been proven safe and will cause more harm than good. <br /><br />We have evidence for the former position:<br /><a href="http://www.cdc.gov/h1n1flu/vaccination/acip.htm">http://www.cdc.gov/h1n1flu/vaccination/acip.htm</a><br /><a href="http://www.cdc.gov/h1n1flu/pubs/">http://www.cdc.gov/h1n1flu/pubs/</a><br /><a href="http://www.who.int/wer/2009/wer8436.pdf">http://www.who.int/wer/2009/wer8436.pdf</a><br /><a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2691743&tool=pmcentrez">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2691743&tool=pmcentrez</a><br /><br />Evidence for the Latter Position:<br /><a href="http://swinefluswindle.com/">http://swinefluswindle.com/</a><br /><a href="http://www.rense.com/general86/dngers.htm">http://www.rense.com/general86/dngers.htm</a> (please check out the home page - it is one big ad for conspiracy and health products - dubious ones)<br /><br />The latter is just s sample of the conspiracies out on the web. Most use news articles as their source, or other like-minded blog posts. The former uses science. <br /><br />Here is an article by Dr. Harriet Hall talking about all of the myths surrounding the Swine Flu. If you read nothing else, this will be a great guide through the jungle of swine flu fears.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com1tag:blogger.com,1999:blog-8324600872523213228.post-51827225984885996192009-09-11T08:26:00.000-07:002009-09-11T08:49:32.028-07:00Skeptically Speaking and DarwinI will break my constructive silence to make a quick plug for a radio program that I will be appearing on tonight. It is called <a href="http://www.skepticallyspeaking.com/">Skeptically Speaking</a> tonight a 8pm EST on CJSR FM88.5 out of Edmonton Alberta. You can also listen to it online by visiting the website above.<br /><br />I am Speaking Up about <a href="http://www.darwin150.com">Darwin150.com</a>, the group that is promoting the Darwin Facebook Group in which we attempt to get one million members to sign up by November 24th, the 150th anniversary of the publication of <a href="http://www.amazon.ca/Origin-Species-Facsimile-First/dp/0674637526/ref=pd_ybh_1?pf_rd_p=289713001&pf_rd_s=center-2&pf_rd_t=1501&pf_rd_i=ybh&pf_rd_m=A3DWYIK6Y9EEQB&pf_rd_r=0KSYNQZ31XF57ZM88PEE">On The Origin of Species</a> by Charles Darwin. Darwin150.com has put together a free lecture series being webcast and available via phone, skype or live. Our group has attracted a number of very high profile scientists and science journalists to talk about the various aspects of evolution, and if the previous lectures that we have sponsered are any judge, then they are bound to be enlightening and accessible to everyone.<br /><br />The broadcast tonight will also feature (also, as if; more like star) Richard Saunders, noted Australian skeptic and the host of <a href="http://www.skepticzone.tv/">The Skeptic Zone</a> podcast, so it will be sure to be well attended.<br /><br />Dana Blumrosen and I have started a new group of Facebook called <a href="http://www.facebook.com/home.php#/group.php?gid=269110640607&ref=ts">Queerly Skeptical</a> as well, a group dedicated to the promotion and advancement of critical thinking and focused on building community in the small LGBT skeptic community.<br /><br />So, check these things out and I will be continuing a bi-monthly blog post about the fearsome things in society that paralyse a few and bother the many. Stay tuned!Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-9556471710200160272009-07-30T09:58:00.000-07:002009-07-30T10:05:02.377-07:00New look for the Anxiolysis BlogAnother Toronto-based skeptic known as The Washed and I are working on pimping up my blog! He has kindly offered is services as a web developer and I have gladly accepted. As such, my output on this blog will be attenuated (even after I finish my <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">English</span> composition course) and we will be launching a new <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Anxiolysis</span>, or perhaps a re-branded blog, later this year.<br /><br />The timeline is very hazy and we have yet to lay one out, but I hope to be a bit more prolific in my posting. I will probably be moving to another provider as well, as blogger is not as <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">flexible</span> as other formats. I will keep you <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">apprised</span> and hope to be blogging again soon!<br /><br />Stay tuned! ( or at least check in once in a while...)<br /><br />cheers<br />Michael <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Kruse</span>,<br />The Anxious MedicMichael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-39232114748415834332009-07-13T01:59:00.001-07:002009-07-13T04:14:53.568-07:00TAM final dayToday was the final day of TAM and I spent the morning listening to the presentation of papers by different individuals on rational inquiry into various subjects. Canada was represented byDavid Green, senior Patent Examiner fro the Canadian Intellectual Property Office. He told us the story of the <a href="http://www.theperfectsommelier.com/">Perfect Sommelier</a><nofollow> which purports to increase the quality of a cheaper wine with the use of magnets. He was able to scare the company away from further seeking patents in Canada with the use of a randomised control trial, the gold standard of scientific inquiry, that showed that the device made no difference to the taste of cheap wine.<br /><br />The rest of the morning was much the same and had the general theme of the application of critical thinking when engaging with the larger world. One very good presentation was on how to focus your web presence given your audience. I started this blog not quite knowing what I wanted to focus upon or even who my audience was. It soon became clear that I was more interested in tackling the reasons behind fear and anxiety in our society, and with rational thought and as much research as I was capable of, promote a science based inquiry into pseudo-scientific claims that were are motivated to believe due to this fear and anxiety.<br /><br />Though many of my friends may, by now, be thinking that I have drank the cool-ade at some cult-like retreat, I would offer that I have found a community of individuals from around the world who are very inclusive, charming, and rational human beings and who think nothing of finding the flaws in one another's argument. We believe in two things: accepting a notion as fact when there is evidence to back it up and reserving the right to change our minds when a better solution comes along, and the right of each individual to believe in what ever political or religious ideology they wish, as long as they hold basic ethics and morals that we can all believe in.<br /><br />Today a really wonderful thing happened. <a href="http://www.randi.org">The James Randi Education Foundation</a>, the organisers of the conference, have what they call, the Million Dollar Challenge. It is one million dollar fund that will pay out if anyone can proove the existance of a paranormal activity. ESP, telekinesis, dowsing, psychic ability etc. is all up for testing, under the strict scientific protocols that have to be agreed upon by both parties. Today a dowser, Connie Sonne, stepped up to the bar and it was arranged that a preliminary trial of her powers would be tested at TAM 7. The methods of the experiment and its exact outcome can be found at the <a href="http://www.randi.org/">JREF</a>, but I can say she failed to get even close to proving her powers. What was amazing was that a room of around 700 delegates, skeptics all, remained perfectly silence while she attempted the test. There were 1700 people online viewing the procedure and they stated that they did not know there was an audience in the room until the camera zoomed out at the end. There was no hooting or cat-calling or even a twitter of laughter at the end of the test. On the forum there was, mostly, respect maintained for Ms. Sonne and thanks to her for participating.<br /><br />I was really hoping that the test would prove positive. Ms. Sonne had a 1 in 1000 chance of making the correct guesses and, though pretty good odds, it would have been somewhat exciting to have a positive preliminary test. This was not the case, however and she failed entirely. She made some post hoc rationalisations about the spirits not wanting to reveal her powers but no matter, it did not work. I was very impressed with the respect given to Ms. Sonne and it made me very proud to be a part of that audience.<br /><br />I made some good connections today and even got to have a picture taken with James "the amazing" Randi who also inscribed a book of his for me. It was a real pleasure to have met him and he remains a man of great inspiration for the struggle to tell the truth. I also made contact with Desiree Schell from Skeptically Speaking, a weekly radio broadcast from the U of A and an engineer with <a href="http://www.skeptography.com">Skeptography</a>. Hopefully I will be able to provide some content for both of these projects in the future.<br /><br />We had a great time at the Penn and Teller show tonight. Their bit on cold and hot reading was great and the bullet catch is classic. Quite an awesome show.<br /><br />I go back to Toronto later today and I am excited to get back to school and work. This was a great session and we will return next year. There is much more to see in Vegas, but I would not care if it was in Nebraska or Minnesota, the people are what make TAM enjoyable and I will be happy to see them again in one year's time.<br /></nofollow>Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-63396888904768439232009-07-11T01:04:00.000-07:002009-07-11T01:52:20.991-07:00TAM Day 2I find myself starting this blog posts quite inebriated. Most of my good conversations comes from mingling with other delegates at the bar after the days performance. Dave and I spent the night drinking with Anthony from Edmonton, occasional contributor to the <a href="http://www.skepticallyspeaking.com">Skeptically Speaking</a> radio show from the University of Alberta. I am getting the feeling that this is the way things are parsed at TAM. We all sit in a large ballroom listening to what amounts to quite a brilliant array of interesting people tell us what they have been up to in the skeptical or science world, then we all retire to the bar to disagree with them.<br /><br />I had to awkward pleasure to sit beside <a href="http://www.sciencebasedmedicine.org/?author=8">David Gorski</a>, a surgical oncologist and a contributor to the Science Based Medicine blog and the man whose skeptical Oprah article was published in the <a href="http://www.sciencebasedmedicine.org/?p=497">Toronto Star</a> a month ago. During <a href="https://www.broadinstitute.org/about/senior-staff/fintan-r-steele">Fintan Steele</a>'s talk about the problems with<a href="http://www.mayoclinic.org/campaign/individualized-medicine.html"> individualized</a> medicine, Dr. Gorski had took issue with several of Dr. Steele's comments about chemotherapy, stem cell research and gene therapy - specifically that they would be either laughed at or come to dead ends in the near future. Dr. Gorski is a surgical oncologist, and deals mostly with solid tumors of the breast, and his talk during the Science Based Medicine conference dealth with, among other things, how chemotherapy is a good adjunct to surgical abatement of solid tumors, rather than the toxin and poison that the naturapathic folks would have us think.<br /><br />This open, albeit polite, conflict is what The Amazing Meeting is all about. Science and skepticism is dirty and hard. Alternative therapists think nothing of telling their patients that that they will cure what ever their patients are complaining of, even vague symptoms of fatigue, lethargy or generalised pain. Physicians, on the other hand, have science and statistics to answer to and rarely tout any of their therapies as a cure and will often couch the treatment in a way that gives the uncertainty - an unfortunate but very real aspect of real life - of a treatment its due. What doctors do have going on their side, however, are real, tested facts, not conjecture or magic, and it is this that is very unpalatable to the general public, no matter how true.<br /><br />Our genetic legacies are only one aspect of our bodies health, and environment and epigenetic inheritance play as big a role in the expression of our genes. This was argued by Fintan Steele, a former monk and ordained catholic priest and now a doctor and researcher. This caused Dr. Gorski to roll his eyes a few times but this kind of controversy is one we can handle. <br /><br />I met many people today in the course of conference and one thing is abundantly clear: this is a big tent. <a href="http://blogs.discovermagazine.com/badastronomy/">Phil Plait</a>, the president of the <a href="http://www.randi.org/site/">JREF </a>(<a href="http://www.youtube.com/watch?v=-0H0r2Xqlgs">James Randi</a> Education Foundation) several times in his speech made a point of saying that we are made up of disparet political and religious views but we are all welcome at the JREF and in the skeptical community. At this conference there are atheists, catholics, protestants, agnostics, libertarians, democrats, socialists and republicans but we all share one thing in common: a belief in the reliability of the scientific method. The truth is something we cannot ignore. Even more, we cannot ignore a change in the accepted wisdom.,<br /><br />The theory behind chiropractic has not changed in over one hundred years, since <a href="http://en.wikipedia.org/wiki/Daniel_David_Palmer">Daniel David Palmer</a> first proposed his theory of subluxation, but in the past 100 years, medicine, physics, chemistry, biology and all of the other sciences have time and again changed their outlook on the world in order to accommodate new findings and fresh and irrefutable research. Irrefutable, that is, until the next time it is refuted. When asked what it would take to convince the anti-vaccinationist camp of the safety and efficacy of vaccines they have no answer. They insist that they want vaccines to be safe for children but they refuse to quantify it and therefore render their position nothing more than empty ideology and conjecture.<br /><br />There is plenty of conjecture in science, but we have a way of testing it and everyone, well, mostly every one, will change his or her point of view given enough evidence to overturn accepted principles, no matter how entrenched.<br /><br />The result of this effort this weekend is a community that is very diverse, forward looking and very inclusive. Tomorrow David and I are meeting up with a bunch of the other lesbian, gay. bi and transgendered (though I have yet to meet any transgendered skeptics here) for lunch. There are more than few of us: at last count I counted about 15 or 20 at the bar tonight. This inclusiveness is true regardless of where you are from or your political outlook. It is a true community.<br /><br />Tomorrow we will hear about more innovation and discovery and grow even closer together. But, as <a href="http://en.wikipedia.org/wiki/Penn_Jillette">Penn Jillette</a> of Penn and Teller fame plays with his kids by chasing them around the lobby with a balloon animal on his head, we will learn to communicate better with each other and, hopefully, learn to communicate the lesson of the scientific method and the power of doubt to our families, friends and society at large, in a way that does not further alienate those whose power of reason has been addled by ideology and fear.<br /><br />p.s. James Randi, our great leader (hee hee) has quite a fantastic magical legacy. The James Randy link above will take you to a breath-taking video on You Tube of The Amazing Randi performing a straight jacket escape while suspended upside down from a crane over the Canadian Niagara Falls - in January!! It was so cold, he told us today, that his beard had completely frozen and he could not speak. AwesomeMichael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com1tag:blogger.com,1999:blog-8324600872523213228.post-60961074184455990702009-07-10T01:30:00.000-07:002009-07-10T02:14:43.904-07:00TAM 7 Day 1Drinking in the bar tonight, after a day of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">extraordinary</span> seminars, I found a great community in fellow Canadian Skeptics. We all met at a bar across the street and all were branded with maple leaf stickers so we would not lose each other in the crowd.<br /><br />There seemed to be an extra-ordinary amount of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">delegates</span> from Alberta, land of oil and Klein, and they are all young, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">enthusiastic</span> and very motivated. Us few <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Torontonians</span> should pull our bootstraps up and get our game together if we are going to compete with the westerners game!<br /><br />Two great podcast projects <span class="blsp-spelling-error" id="SPELLING_ERROR_4">revealed</span> tonight: <a href="http://www.skeptographers.com/"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">Skeptographers</span></a>, a new podcast relying on the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">participation</span> of all Canadian skeptics is an <span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">innovative</span> way to get the message out and not require the amount of mic time that the bigger <span class="blsp-spelling-error" id="SPELLING_ERROR_8">podcasts</span> require. I will be putting a small proposal for a 7 minute segment for them soon - awesome, and <a href="http://www.skepticallyspeaking.com">Skeptically Speaking</a>, a Canadian skeptic call-in and interview show <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">represented</span> by Desiree <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Schell</span> the host.<br /><br />We were <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">regaled</span> at the bar of tales of <span class="blsp-spelling-error" id="SPELLING_ERROR_12">Toby:</span> the large skeptical viking that set out to kiss every man at the Del Mar bar last night: and we were not-so-secretly sad to have missed it. There were loads of gay skeptics we hooked up with tonight which caused to focus on one of the more <span class="blsp-spelling-corrected" id="SPELLING_ERROR_13">lovable</span> aspects of the skeptics community; they are very <span class="blsp-spelling-error" id="SPELLING_ERROR_14">openly</span> accepting of the queers in general. Indeed there are even some high profile queer skeptics, DJ <span class="blsp-spelling-error" id="SPELLING_ERROR_15">Groethe</span>, host of the <span class="blsp-spelling-error" id="SPELLING_ERROR_16">CSI</span> podcast from buffalo being the most <span class="blsp-spelling-corrected" id="SPELLING_ERROR_17">recognizable</span>.<br /><br />I am, however, quite inebriated at this point and an eight o'clock start time looms. I will be covering all of the great stuff we learned at the Science Based Medicine conference today, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_18">including</span> how to choose a safe <span class="blsp-spelling-corrected" id="SPELLING_ERROR_19">chiropractor</span>, at a later date.<br /><br />A great day - just smart awesome fun.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-47911466507167777182009-07-08T22:52:00.000-07:002009-07-08T23:26:31.618-07:00Tam 7 PreambleWe arrived in <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Las</span> Vegas, Nevada today for the start of <a href="http://www.randi.org/site/index.php/component/content/article/37-static/445-the-amazing-meeting-7.html">The Amazing Meeting 7</a> at the South Point Casino. The flight down was uneventful but it became immediately obvious that the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">UFC</span> 100 fight on Saturday night will be competing with our brainy-<span class="blsp-spelling-error" id="SPELLING_ERROR_2">polooza</span> this weekend. We will see who will tap out first! (<span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">OK</span>, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">OK</span>, our <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">scientists</span> don't have sleeve tats and are not experts in <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Muay</span> Thai, but give them some liquid nitrogen and a balloon and they can do some serious damage...)<br /><br />David Steele, my traveling companion and fellow skeptic, and I noticed at <span class="blsp-spelling-error" id="SPELLING_ERROR_7">check-in</span> that those joining us are indeed hard-core science types - odd facial hair, strange <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">conversations</span> about cold fusion that would shame Ponds and <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Fleischman</span> and rumours of another proposed net-energy process being <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">announced</span> - and that is only in line at check-in; I can hardly wait what tomorrow will bring as we start the alternative medicine <span class="blsp-spelling-error" id="SPELLING_ERROR_11">CME</span> conference.<br /><br />We trekked downtown the day before <span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">registration</span> to take in the orgiastic <span class="blsp-spelling-error" id="SPELLING_ERROR_13">gambling</span> trap that is downtown Vegas and found some great pop-art at the <span class="blsp-spelling-error" id="SPELLING_ERROR_14">Bellagio</span> Art gallery. Frank Stella, Andy Warhol, and others <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">cleansed</span> our <span class="blsp-spelling-corrected" id="SPELLING_ERROR_16">pallet</span> after gawking at the one half size Tour Eiffel and the completely over-the-top Caesar's Palace. We had some great <span class="blsp-spelling-error" id="SPELLING_ERROR_17">mohito's</span> in front the Palace and we missed the shows at Treasure Island because of wind. It became obvious, however, that unless you are gambling or seeing a show downtown the sensory overload that is downtown <span class="blsp-spelling-error" id="SPELLING_ERROR_18">Las</span> Vegas can be really tiring.<br /><br />We are looking forward to starting the conference tomorrow and I will be blogging about each days events. And I will continue to attempt to avoid pulling on any slot machines - though they are designed to be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_19">irresistible</span> and my lizard brain keeps going to my wallet......Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-33307232236981388162009-06-02T10:06:00.001-07:002009-06-02T12:10:28.124-07:00Silence is the EnemyI have been largely silent for the last several months; mostly because I have been taking an English composition course and all of my writing time has been spent doing that. Today, however, I am breaking my self-imposed silence to join many <a href="http://www.facebook.com/group.php?gid=88260307629">bloggers </a>to spread the word on the terrible crisis in <a href="http://www.state.gov/r/pa/ei/bgn/6618.htm">LIberia </a>concerning rape and abuse of women and children.<br /><br />I was not very aware of the war in Liberia up until the last couple of months. The appearance of the first women president in Africa Ellen Johnson Sirleaf on The Daily Show last month was my first introduction to the country's recent tumult. Originally re-colonised by freed American slaves in 1820, Liberia was in a war-like stance since the ruling party from American Colonial times, the True Whig Party, was toppled in 1980 and the first home-grown party in 120 years took over. This party, formed by military coup and led by President Doe, was dominated by one ethnic group in a state with 4-5 distinct groups that have been vying for power and fighting against oppression since the first outbreak of civil war in 1986.<br /><br />Charles Taylor won the first elections in 1994 and did little to improve the country, and in 1999 civil war broke out once more until peace was brokered in 2003 by other African states. Sirleaf has since led a very competent and highly functional government that is well-respected and supported by most international states but one very dark hold-over from the 20 years of civil strife remains: a culture of rape.<br /><br />In an op-ed piece from the <a href="http://www.nytimes.com/2009/05/21/opinion/21kristof.html?_r=2">NY Times</a> Nicolis D. Kristof spells out what, to me, are horrible statistics of the worse kind of child abuse and torture. Twelve percent of children under the age of 17 report being raped at least once in the last 18 months. Of all of the rape victims in the country, 61% are estimated to be under 12 years old. Kristof tells the story, confirmed by the International Rescue Committee of a culture of rape that still exists in the country where girls are forced to have sex with teachers for good grades and no one is safe from wanton abuse.<br /><br />A science-blogger led movement to further expose these sickening statistics to western audiences is underway and a collection of bloggers are donating their monthly revenue to <a href="http://doctorswithoutborders.org/">Doctors Without Borders</a>. I encourage you to visit these sites, read what they have to say and keep the traffic up. As well, a letter to your MP or the PM about Canada's reaction to this ongoing tragedy would be great as well.<br /><br /><a href="http://blogs.discovermagazine.com/intersection/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow"><span>http://blogs.discovermagazine.com/i</span><wbr><span class="word_break"></span>ntersection/</a><br /><a href="http://scienceblogs.com/isisthescientist/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow"><span>http://scienceblogs.com/isisthescie</span><wbr><span class="word_break"></span>ntist/</a><br /><a href="http://scienceblogs.com/aetiology/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow">http://scienceblogs.com/aetiology/</a><br /><a href="http://scienceblogs.com/bioephemera/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow"><span>http://scienceblogs.com/bioephemera</span><wbr><span class="word_break"></span>/</a><br /><a href="http://scienceblogs.com/neurotopia/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow">http://scienceblogs.com/neurotopia/</a><br /><a href="http://scienceblogs.com/authority/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow">http://scienceblogs.com/authority/</a><br /><a href="http://scienceblogs.com/drugmonkey/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow">http://scienceblogs.com/drugmonkey/</a><br /><a href="http://scienceblogs.com/ethicsandscience/" onmousedown="return wait_for_load(this, event, function() { UntrustedLink.bootstrap($(this), " 47aa7bbc75383a0906c55236c4f03159="" target="_blank" rel="nofollow"><span>http://scienceblogs.com/ethicsandsc</span><wbr><span class="word_break"></span>ience/</a>Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-77011545390468568752009-01-31T13:57:00.000-08:002009-01-31T14:16:33.512-08:00"Mommy, don’t."The recent conviction of the Nova <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Scotia</span> women Penny <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Boudreau</span> for the murder of her daughter Karissa gave me great pause yesterday. I had not heard of the original crime a year ago but was quite confounded by the murder of a daughter by her mother. There is a great article in The Chronicle Herald from Halifax Nova <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Scotia</span> that gives a great context of this most <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">horrible</span> crime:<br /><br /><a href="http://thechronicleherald.ca/Opinion/1103901.html">http://thechronicleherald.ca/Opinion/1103901.html</a><br /><br />The reason given by Penny was that she was threatened a break-up by her boyfriend if the daughter did not leave. When did killing her become the only option? When did the boyfriend become a larger priority than her 12-year old daughter?<br /><br />Who can say? Somethings we can only guess at.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-76065295628116279732009-01-29T19:22:00.000-08:002009-01-29T20:50:45.303-08:00Water Water Everywhere and ne'er a Thought to ThinkWater is an essential ingredient for life on our planet. Without it we would perish. Many organisms have come up with ingenious ways in which to conserve it in the driest of environs and many humans waste it like...well, water. In most cultures water plays a significant part in religious rights and beliefs. <a href="http://en.wikipedia.org/wiki/Greek_sea_gods">Greeks</a>, <a href="http://en.wikipedia.org/wiki/Achamana">Hindu's</a>, <a href="http://en.wikipedia.org/wiki/Holy_water">Christians</a>, <a href="http://en.wikipedia.org/wiki/Nerthus">Nordic</a>, and <a href="http://en.wikipedia.org/wiki/Water_goddess">many other cultures</a> all have rites and gods focusing on water.<br /><br />It is no wonder then that the world of <a href="http://skepdic.com/woowoo.html">Woo</a>, or pseudoscience, has focused so many efforts peddling various nefarious products based on the supposed magical properties of water.<br /><br />I was struck this week by a Pt I saw who was on several homoeopathic medicines and who had called 911 because one of their children had drank the parent's preparation instead of their own. The entire glass of medicine was drank by the young child. Imagine the parent's horror and worry when they thought their child had overdosed on homoeopathic medicine!<br /><br />Well, I told the parent, this medicine is very dilute but we are glad to take your child to the hospital to be checked out by the doctor. What I really wanted to say would have landed my in a lot of trouble and offended the parent but here is the gist of it.<br /><br /><a href="http://en.wikipedia.org/wiki/Homeopathy">Homoeopathy </a>is based on the magical belief that if you expose the body to agents that would cause the same symptoms in a healthy person as those you are experiencing because of an illness, the body will be able to cope with and rid the body of the offending illness. What homoeopathic doctors don't say is that the agents are so dilute as to be absent from the preparation you are taking. The preparation is in fact water. This is chemistry pure and simple. This science blog, <a href="http://scienceblogs.com/insolence/2006/06/your_friday_dose_of_woo_its_no.php">Respectful Insolence</a> has a great entry on the mathematics around it. any prep that shows an ingredient with a 12C or 24X concentration has in fact less than one MOLECULE (o.6 molecules to be exact) of the original agent in it. (C means base 100 so 12C is 100^12, so a 12C prep has been diluted to a concentration of 1/1 000 000 000 000 000 000 000 000, or one billion-billionths, X means base 10 so 24x is is the same as 12C.) <a href="http://en.wikipedia.org/wiki/Samuel_Hahnemann">Homoeopaths</a> and their founder claim that by shaking the subsequent dilutions the water retains a memory of the original substance so all you need is the water and you are good to go.<br /><br />Pure chacanery - oh and did I tell you that one of the preps that I saw this week was $17.95, for about two ounces of water? If that was not dilute enough for you, you further dilute the prep by putting 5 drops, about 0.5 ml into a 500ml glass of water. Thats a further dilution of 1/1000. that puts the price of a 20 ounce bottle of water at about 179 dollars. Must be pretty good water.<br /><br />Oh, and this week I heard that in the <a href="http://www.guardian.co.uk/science/2006/jul/14/medicineandhealth.lifeandhealth">UK </a>they are selling homeopathic preps to people with Malaria and telling them to stop taking their allopathic or conventional medical drugs. There goes infection control.<br /><br />In an even more outrageous <span style="text-decoration: underline;"></span><a href="http://www.hado.net/index.php">attempt </a>to sell us crap and take food from the mouths of our children is a Japanese "doctor" Dr. Masaru Emoto who claims that water crystals can hear our prayers and that large bodies of water can be changed, on the molecular level even, by our thoughts, words written on a peace of paper or said aloud. What's worse is they are now selling <a href="http://www.h2omwater.com/home.php">bottled water</a> (a scandle at the best of times) with words of peace printed on the lable that affect the water so as to make it peaceful and spread loving feelings among the people drinking it. Instead of selling crap how about we talk to one another with respect and support international efforts like <a href="http://www.unicef.org.uk/">UNICEF</a>, <a href="http://www.amnesty.org.uk/">Amnesty Internationa</a>l and the<a href="http://nobelprize.org/nobel_prizes/peace/laureates/1910/peace-bureau-history.html"> International Peace Bureau</a> instead of trying to allay our fears of future strife and conflict by drinking magical bottled water - a practice that many in itself cause more wars in the future than anything else in <a href="http://www.nytimes.com/2007/09/28/world/asia/28water.html">China</a>, <a href="http://www.arlingtoninstitute.org/wbp/global-water-crisis/606">India</a>, <a href="http://news.bbc.co.uk/1/hi/world/asia-pacific/3992231.stm">Australia</a> and even here at home in <a href="http://www.canada.com/vancouversun/news/story.html?id=1d324e25-0a20-4e3e-b1ba-ea2f35386bb0">Canada</a>.<br /><br />Water is important and it is no wonder that we have raised it up to sacred levels in our societies. It is distressing however to see anxiety about our health and well-being contribute to poor choices and throw rationality out the window. So much so that a parent called 911 because their child had drank a glass of water. That ranks right up there with the "slivers" and "eyelash in eye" call last fall, I think.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-60414406691131380962009-01-14T08:29:00.000-08:002009-01-14T09:50:03.697-08:00Lake Michigan Stone Henge???I found <a href="http://io9.com/5130669/another-stonehenge-discovered-under-lake-michigan">this </a>story on Digg today describing a supposed stone circle made by ancient North Americans and long buried under Lake Michigan. The <a href="http://bldgblog.blogspot.com/2009/01/stonehenge-beneath-waters-of-lake.html">BLDGBLOG </a>has pretty credulous opinions about the site as well.<br /><br />I think they are FOS though. The rocks at the bottom look pretty random to me but are made to look like they belong through an artifact of the imaging technique. It is the same phenomenon that takes place when you shine a point source on an ice rink - all of the marks on the rink around the reflection of the light look like they are forming regular, even mechanical, circles. I believe this is an illusion created by the refraction of light back toward the point source and only those cuts that are perpendicular to the light source will reflect back, thus creating the illusion of a circular pattern in the ice.<br /><br />The picture taken on the bottom of Lake Michigan appears to be the same. Place a light source (or sonar source) in the middle of a bunch of debris and the shadows created will make all of the debris look like it belongs together. The lensing of the camera has a lot to do with it as well, as an extreme wide angle lens will make the picture look more circular and thus falsely connect the debris together in an illusion of a pattern. If you shined a light from above and used a narrow lens from further away I would bet the circle would look like it really is: a bunch of rocks at the bottom of Lake Michigan.<br /><br /><a href="http://www.beaverisland.net/Projects/The_Stone_Circle/the_stone_circle.htm">Stone circles</a> are not unheard of in North America. Some were called <a href="http://library.thinkquest.org/C0118421/wheel.html">Medicine Wheels</a> by the early European explorers. According to my cursory research, the stone structures built by the original people's of North America appear in the Northwestern US, not in the Great Lakes region at all. The function of the Medicine Wheels is not known although archaeologists have speculated that much like the European stone circles the wheels had a celestial purpose.<br /><br />On the more wacky side, a collection of rocks piled up over many years as a byproduct of land clearing and farming in New Hampshire called <a href="http://en.wikipedia.org/wiki/America%27s_Stonehenge">America's Stonehenge</a> has been a destination for kooks and crooks alike since the 1930's when the land was purchased by an insurance salesman and opened as a tourist trap. William Goodwin and his ideological heirs purport that the site is the proof that the Celts were on the North American continent and that the site has connections to the ancient Phoenicians, of all people. Of course archaeologists doing some real science and research on site have proposed that the stones are there as a byproduct of farming and its spin-offs. As we now definitively that farmers have been in the area since the 18th century and we have no proof that the Celts or Phoenicians ever made an appearance, I will go with the farmers for now.<br /><br />The ritual piling of stones has been an activity of humans for many thousands of years. In many cases they are tied to recording and predicting the yearly calender and seasons. Sometimes though, a pile rocks is just a pile of rocks.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-80357961582140938732008-12-09T18:48:00.000-08:002008-12-11T08:29:34.783-08:00Life on the Edge of the PrecipiceI have arguments with friends about my skeptical outlook on life and one argument is always put forward: that I and my skeptical colleagues don't allow ourselves to believe in alternative views of the universe because our minds are closed to to possibility of new and novel things that are unexplained by our current knowledge of the world.<br /><br />This is a view often expressed by those hard core science deniers as well as those with a magical or even slightly non-material view of the world. When skeptics attempt to explain unusual events with solid science they are accused of having a closed mind, of taking the magic and wonder out of life and often of killing "fun".<br /><br />I think this is born out of a fundamental misunderstanding of how the scientific method is used to know the world. Let me assert that I think this is a direct result on how science is taught at the high school level; often the only time that the general public will ever have direct contact with the scientific process. High School science is not about discovering new things it is about imparting the basic facts so that students can have a general idea on how science views the world in order to prep the student for more complex ideas in university. We are given a lesson on how waves propagate and we do an experiment with an hypothesis on how the water will react in a water table. This experiment, even if done only partially right, will often reinforce the ideas that were covered in the lesson. Nothing new is discovered but we get an understanding of the physics of the wave - an important lesson when we look at many areas in physics later. The same goes for chemistry: an experiment is done to show a displacement reaction between two chemicals, thus proving the theory of <span class="blsp-spelling-error" id="SPELLING_ERROR_0">electronegativty</span> or whatever. It all reinforces the ideas covered in the lesson, there is nothing new.<br /><br />Real science is performed quite differently. It starts out with a question about the world and how it works. Then we research the current level of knowledge and identify an area where this knowledge is in deficit. This is where things diverge from high school science. The procession of science is the discovery of the unknown. Very often the outcomes are inconclusive and the experiments have to be re-fined and repeated. Adulterations in the sample(s), too many variables left uncontrolled or not eliminated, faulty human processes, <span class="blsp-spelling-error" id="SPELLING_ERROR_1">miscalibrated</span> equipment, too small a sample size, unrefined questions, poor record keeping and, yes, bias's of the researches cloud the results and the experiment must be repeated.<br /><br />Once you have refined and refined the experiment to uncover the truth often the results are completely unexpected. During the original assay of the knowledge a theory starts to be formed as to what you think might be happening. Often this directs the experiment in the right direction and often it can misdirect and waste time. It is when the outcome completely surprises the researchers that science dazzles.<br /><br />Listen to any mainstream science program, like <a href="http://www.cbc.ca/quirks/">Quirks and Quarks</a> on CBC radio one or <a href="http://www.sciencefriday.com/">Science Friday</a> on NPR and you will hear time and again scientists recalling how the results of their research were completely unexpected and even weird and counter-intuitive. When a new phenomenon crops up it is often not explainable right away. Scientists are often "baffled" or "flummoxed" in headlines. This inability to explain nature is what drives science; it is the reason science exists; it is the reason given by many scientists as to why they went into science in the first place: to discover new and wondrous things.<br /><br />The difference is scientists do not stop there - they do not invoke a god or the ubiquitous "energy" or the supernatural to explain things, they continue to dig and find out what is at the heart of this new phenomenon. Often the pseudo-scientists and alternative therapy types think researchers run scared when something exists that science cannot explain but that is where science lives. That is where "wonder" is found.<br /><br />Scientists miss things when they do not have an open mind. When they make assumptions at the point of departure from the known they do not explore new avenues, they just search for new evidence to support their long held beliefs. This is the pit-fall of the pseudo-scientists, who regularly cherry-pick data to support their presuppositions. Ask a scientist what they would do if data arose that completely nullified their theory and they would see an opportunity to grab a place in history and discover something new. Ask a pseudo-science true believer in alternative health therapies or free-energy thinker or HIV-denier what they would do if evidence showed that their theories <span class="blsp-spelling-error" id="SPELLING_ERROR_2">were</span> completely false? They insist that the data is incorrect and that they just KNOW that they are right.<br /><br />Who's mind is closed now?<br /><br /><span style="color: rgb(255, 102, 102);">Addendum</span>: <a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0020124&ct=1&SESSID=9c261cff74cf0d00437095f117944115">Here </a>is a paper discussing the usual outcomes of scientific papers - it is valuable to think of this when checking out claims of legitimate scientists and of pseudo-scientific papers - like those ascribing effects to acupuncture and the like. As well, check out this wiki on <a href="http://en.wikipedia.org/wiki/P-value">P-value</a> - it discusses how the data from a study is assessed against random chance.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-4664062413980667022008-11-23T22:54:00.000-08:002008-11-23T22:56:44.077-08:00Name ChangeHi there. I have changed the name of the blog to Anxiolysus, which means to rid something of anxiety. The Church theme in the title was a bit too ironic to me and actually bugged me a lot so - goodbye! The new name more concisely conveys what I would like the blog to convey.<br /><br />So. that is all. Enjoy, and I welcome your comments.<br /><br />The Anxious MedicMichael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-34720237278810694092008-11-09T11:17:00.000-08:002008-11-17T05:00:19.122-08:00As a man thinks in his heart, so is he. [Proverbs 23:7]I have told many people who ask that the majority of the calls I respond to on a daily basis have, at their root, general anxiety. Whether this is the primary cause for the 911 call - an anxiety attack - or whether anxiety secondary to a perceived life-threat, it seems that it is the reason for the call for help.<br /><br />Rarely the cause for alarm is serious and can be quite frustrating as a health care provider. Emergency rooms are filled to capacity most days and the waits can be long. Many times the people waiting to be seen are not acutely ill or are having difficulty managing their chronic conditions and very few are true emergencies. A new study by the Centre for Addition and Mental Health in Toronto has pin pointed a specific case of increased use of the health care system with curious findings. They studied people who had recently had a heart attack and controlled for those with depression symptoms or a history of them. They found that depression alone had a marked increase in use of the health care system: 9% increase in heart-related hospitalisations, 24% increase in total hospitalisation days and a whopping 43% increase in non-heart related hospitalisation days after being discharged for the primary heart-attack.<br /><br />What is even more shocking is the less-serious the heart-attack the more depression the patients showed and the increased use of the health-care system.<br /><br />I go on many calls in a week where a person has requested 911 service for what is at the core a benign event but what is perceived as serious. A child falls off the bed and hits a carpeted floor. Hyperventilation. A person assaulted with a small scratch on the upper arm. There were two separate calls for wood slivers and an eyelash in the eye. What are people thinking? I think people are scared. The general level of anxiety in the population is very high - uncertainty abounds over whether terrorists will bomb us - whether global warming will kill us - will there be enough oil. People have become incapable of assessing risk and see everything as a threat.<br /><br />I listened to a great <a href="http://www.tvo.org/TVOsites/WebObjects/TvoMicrosite.woa?bi?1225569600000">Big Ideas</a> podcast this week wherein a debate was conducted over the best way to affect social change. One of the speakers argued that public education was generally a poor way to affect change - that it did not work. He cited breast cancer prevention lectures, seat-belt education as examples. I could offer the recent commercials for stroke as another. It seems that real social change on buckling up only came about after the introduction of seat belt laws for children and the social pressures that the children had on their parents when they asked their parent why THEY were not wearing their seat belts.<br /><br />I do not know what the answer is. I try to educate my patients about what they perceive is going on in their bodies and what I think is really going on. I never say "you do not need to go the hospital" though some medics choose too. I can only hope that the long waits at hospital act as a deterrent for those seeking primary medical attention, like that of a family doctor, at an acute care facility. Some feel we should charge more to take an ambulance. In most cases it already costs more than a cab and what if you cannot pay? It would be a tragedy for someone to refuse an ambulance who really needs one on the grounds of inability to pay.<br /><br />I think the larger solution has nothing to do with health care; if it did we would have a chance of fixing it internally. It is a question of reducing uncertainty in society. We should publicly shame politicians and officials who use fear for political points. We should share information openly and include the public in the decision making process in government. We can try to ensure that people who have gone through a life-threatening emergency have the appropriate follow-up education and care and good primary medical care.<br /><br />Above all we should try to instill in our children a self-sufficiency that will help them to try solve their own problems before asking everyone else for help.<br /><br />Like getting an eyelash out of your eye.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com2tag:blogger.com,1999:blog-8324600872523213228.post-74294392217030263662008-10-29T23:17:00.000-07:002008-10-29T23:47:30.992-07:00Believers, make war on the infidels that dwell around you...<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5COwner%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="State"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal">I rode home on the subway today after seeing another Hollywood film trying to show what a quagmire Middle East politics and terrorism are but in fact showing us that brown guys are scary and bad and they see us white guys as the enemy.</p><p class="MsoNormal">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">I looked up from my book when trying to leave the subway and saw several brown faces looking at me casually as I exited.<span style=""> </span>There were South Asian, Persian, Iraqi, or maybe Afghani faces. Some may have been Muslim, some Christian, some atheist, like me. Some may have been fundamentalists or moderates or generally confused like many of us.<span style=""> </span>When I looked back at the brown faces I had a visceral reaction that made me feel I was looking into the faces of the men who were depicted as terrorists in the film.<span style=""> </span>The film had done its job.</p><p class="MsoNormal">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">The idea of community these days is very blurred.<span style=""> </span>We have the community of our immediate family or neighbours.<span style=""> </span>We have online communities or work communities at the end of mobile phones.<span style=""> </span>How do we decide who to trust and who not to trust?<span style=""> </span>If we live outside of the big city we may assume that everyone on the streets of <st1:city st="on"><st1:place st="on">Toronto</st1:place></st1:city> has a gun or a knife and will just as soon as kill you and take your money as look at you.<span style=""> </span>After the attack on the World Trade Centre how many<a href="http://www.pluralism.org/research/profiles/display.php?profile=74090"> </a><a href="http://www.pluralism.org/research/profiles/display.php?profile=74090">New Yorkers</a> saw brown guys with bombs under their coats roaming around <st1:place st="on"><st1:state st="on">New York</st1:state></st1:place>?<span style=""> </span>But those of us who live in <st1:city st="on"><st1:place st="on">Toronto</st1:place></st1:city> know differently; that the streets are largely safe and those acts of random violence are usually perpetrated on people who know each other.<span style=""> </span>Most sexual assaults take place between people who are <a href="http://www.sa.rochester.edu/masa/stats.php">related </a>not between perfect strangers.<span style=""> </span><span style=""> </span>How do we decide who to trust?</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Anthropologically <a href="http://www.syr.edu/chancellor/speeches/Chautauqua_presentation.pdf">arguments </a>have been made that it is important to have <a href="http://greatergood.berkeley.edu/greatergood/archive/2005fallwinter/FallWinter0506_deWaal.pdf">empathy </a>with members of your local social group and not with members of a social group far away because your group needs to work together to survive and the far-away group has no direct impact on this ability.<span style=""> </span>With the advent of modern communications we are able to see and hear the stories of far-away peoples and start to empathise with their emotions.<span style=""> </span>I think this now gives us the imperative to try to understand the “other” like no other time in history.<span style=""> </span>This “other” can impact our lives in real ways; not only through international terrorism but by immobilising governmental efforts using our tax dollars to help them.</p><p class="MsoNormal">
<br /><span style=""> </span></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Often in the past this has taken a colonial bent.<span style=""> </span>We chose to help the hapless savage who does not have the wherewithal to provide for him or herself fresh water or shelter or to conceive of a proper government so we must step in and make sure they follow our example and produce sound democratic environments within which to survive.</p><p class="MsoNormal">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">If we truly made the choice to empathise with the “other” and through modern communications make this person our neighbour we could approach them on equal footing and perhaps ask them what kind of help they require before offering them the help we think they need.<span style=""> </span>Perhaps also we could find common ground with them and thus prevent future acts of terror by helping them to empathise with US.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">As I looked briefly into the eyes of the brown faces staring at me in that subway tonight, I chose to smile as I exited.<span style=""> </span>To say: “I am a friendly white guy” not the “other”.<span style=""> </span>I had a fleeting thought that this smile could disarm the terrorist -- the seeker of paradise – and perhaps prevent catastrophe.</p><p class="MsoNormal">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Take that, <st1:city st="on"><st1:place st="on">Hollywood</st1:place></st1:city>.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-8202805188624131382008-10-11T15:48:00.001-07:002008-11-01T02:32:43.784-07:00Update on "Fear Only the Unknown,"Well, it seems like I hit a bit of a hot topic. Two weeks ago in <a href="http://www.sciencemag.org/cgi/content/abstract/322/5898/115">Science</a>, a weekly peer reviewed science journal - along with Nature one of the most popular - published a report of a study out of the Department of Management of University of Texas at Austin and Northwestern University in Illinois, concerning the perception of control and our human response to it. The study was headed by Jennifer A. <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Whitson</span> and Adam D. <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Galinsky</span><br /><br /><br />It was brought to my attention by <a href="http://www.sciencefriday.com/program/archives/200810037"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">NPR's</span> Science Friday</a> last week and I had to check it out. The researches <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">purport</span> to have found a link between a person's perceived lack of control over their life and their propensity to believe in <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">illusory</span> effects, like seeing patterns in static, or seeing a conspiracy where there is none or even to believe in the paranormal.<br /><br /><br />Six separate experiments were done to test the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">phenomenon</span> and significant percentages of people reported the increased belief in <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">pseudo scientific</span> or magic-based beliefs in moments of crisis or times when they felt they were not in control of the situation. It seems that when we perceive a lack of control over whatever situation surrounds us we are willing to believe the most wacky <span class="blsp-spelling-error" id="SPELLING_ERROR_7">things</span> in order to make sense of what is going on. The participants were witnessed "seeing images in noise, forming illusory correlations in stock market information, perceiving conspiracies, and developing superstitions." They also showed a causal link between the two by showing that building up an illusory structure, "reaffirms the self." It makes us feel better.<br /><br /><br />So the next time you feel cold when walking into a room in a stranger's house think twice about calling it "ghost cold". Call it a draft and get to know the owner.<br /><br /><br />Or better yet, stop lurking in stranger's houses.......creep!Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-31739950052964004632008-10-01T01:38:00.000-07:002008-10-01T02:51:56.720-07:00Some Reasonable Propaganda<object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/_o2_U0ggvb8&hl=en&fs=1"></param><param name="allowFullScreen" value="true"></param><embed src="http://www.youtube.com/v/_o2_U0ggvb8&hl=en&fs=1" type="application/x-shockwave-flash" allowfullscreen="true" width="425" height="344"></embed></object>Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com0tag:blogger.com,1999:blog-8324600872523213228.post-3675421769766527322008-09-04T02:07:00.000-07:002008-09-04T03:14:21.619-07:00Yea, though I walk in the shadow....This week a young boy - a patient of mine - asked me if he was going to die that night.<br /><br />He had been seriously injured but came out luckier than most. The injury missed all of the more life-threatening things it could have hit but still had the potential to be bad. He was scared. More scared than really any child should ever be. He appeared to be from a loving and caring home with parents that cared about him like all parents should care about their child and this recent turn of events was obviously a shock to him.<br /><br />What did I tell him? Well first let me say that we are never supposed to lie to our patients - no matter their age. If they are old enough to ask the question then they are old enough to deserve an answer. The problem of course is that nothing is ever black and white. Ever. I live and practice in the grey. A child however lives in the black and white, more or less. They are just trying to figure out the world and dichotomy allows for easy figuring.<br /><br />In the non-professional world - you know, the real one - our immediate and thoughtless response to any question like this would be: "of course you are not going to die, don't be silly." Is this answer however made to comfort the patient or ourselves? If we have to admit that "yes, there is a chance you could die” and "maybe even right now” and "I am going to be really upset if that happens" and "you had better take the chance to say all of those things that we never say unless we know for sure we are going to die...." then, gee, how could we hold it together for even a moment?<br /><br />I have heard many doctors talk about this decision. Doctors and those who are allowed to diagnose disease in the province are the only ones technically and I think even legally allowed to tell you you are going to die, ya know, for sure. It is called the prognosis of the disease. Think of that - you have to have a license issued by the province to tell people they are going to die. Well that seems silly, doesn't it? I mean, we are all going to die eventually. Ok, so you have to have a license to tell people that they are going to die right NOW. Now? Ah, ya, right now.<br /><br />Oh.<br /><br />Well, that is the big question now, isn't it. What to do with that precious information. More experienced paramedics get to know pretty well when someone is "fixn' ta die" as they said in Iowa where I trained. The patient can get that "thousand-yard stare" and you know they are on the verge. I am not a very experienced paramedic. I have only been on the road for a year and a half and there are many things in the week that surprise me so I am not very willing to tell someone they are going to die.<br /><br />But what to do? The other thing that those doctor types say is that most of the time the person is comforted to have been given the information. They have a chance to get things in order and prepare for a death; a good death; one full of respect and dignity.<br /><br />But what if they are a child? I recently listened to a pediatric oncologist talk about letting children know they were going to die on <a href="http://www.cbc.ca/checkup/WhiteCoatCheckup.html">White Coat: Black Art</a> on CBC Radio 1. She insisted that no child that she had given this prognoses to ever took the news very badly. They were grateful for the information and with the proper support were able to prepare for a good death.<br /><br />It seems to me that the fact that this information is met with a sense of, dare I say, peace is due to the lessening of anxiety. Could the worst part of dying be not knowing you were going to die? If you know you can make decisions, you can prepare. In the end we all want to know right? Unless it happened quickly and sneaked up on us so we did not have time to worry or be anxious, we would all want to know, right?<br /><br />So, what did I tell this young boy when he asked me if he was going to die? I told him "No, you are not going to die." That was the best guess based on the information that I had at the time. I was not sure though and it hurt me just a bit to tell him this. <br /><br />I hope it lessened his anxiety just a little bit, because it certainly did not lessen mine.Michael Krusehttp://www.blogger.com/profile/03853905134553713179noreply@blogger.com3