SullyDogBlog

Politics, Parasites and a Proof-of-Principle

2009-10-29T08:12:00.000-07:00

Now that Max Baucus and Senate Finance have finally pushed their bill out of committee, there are at least five legislatively viable approaches to healthcare reform floating around on the Hill. (Also see this, but quickly, it's all getting dated even as I write.) Given the current political picture, there’s every reason to believe that Congress will push through some sort of healthcare reform legislation, perhaps before the end of the year.

President Obama will sign it, and I’d like to think that he’ll be holding his nose when he does so. That’s because the bill he gets is almost certain to be at least 50% fecal matter by weight.

Oh, sure, there will be a lot of laudable stuff in the final bill. It will cover more people by making healthcare coverage more affordable, it will possibly put something remotely resembling a leash on the for-profit insurance companies, it will probably mandate EMR (which I consider to be a Good Thing) and, most importantly, it will demonstrate an incredibly important proof of principle: health care reform is actually possible.

Remember, a huge array of powerful actors were dead set against any reform at all, right from the git-go-- extremely well-monied and reactionary interests, people who don’t know the difference between a pneumonia and a blister, who would be perfectly happy to let you die in the street if it saved them a dollar on their taxes, the kind of folk who are generally in it for themselves and eat their young. The fact that anything even got out of committee, given the carefully staged town hall outbursts, gazillions spent on disinformation, and hysterical bullshit about "death panels," is something akin to a legislative miracle.

So yeah, the final bill will have a lot of reasonably tasty stuff in it. It will also be at least 50% shit. And what happens, exactly, when you mix tasty stuff with shit?

Still, I’m one of those guys who likes to think that the glass is only half full of shit, and there is a glimmer of hope that the complex, corrupt, mysterious and intensly Kabuki-like process of legislative reconciliation now underway will actually improve on the bills that have come out of committee.

I also play Mega Millions on a regular basis. (I won $3 this morning, woo-woo!).

But hey, there’s always next time (see Proof of Principle, above). And so, for next time, and for the Mega-Millions part of me who hopes against hope that something useful will come out this time, I humbly offer, in all its glorious simplicity, Sullydog’s Overriding Principle for Meaningful Health Care Reform.

Ready, Nancy? Harry? Barack? Olympia? I know you’re reading this.

Brace yourselves.

Here it comes.

Don't spend health care money on people who don't do health care.

That’s it. That’s all there is to it. And from a physician/patient perspective, it really makes a lot of sense. It’s really just a polite way of saying that parasites are very bad for you and must be exterminated without mercy. Huge segments of the health care economy are parasitical, sucking resources out of the system without giving a damn thing back, except increased costs, perverse incentives, and toxic administrative burdens. If a new health care system were to put even a few of these helminths out of business, that would be a prime indicator that something had been done right.

Just to be clear, I'm not talking about people who run hospitals and clinics, critical administrative and support personnel--although truly meaningful reform would reduce the need for administrative support. It takes a lot of people to do billing and wrangle with HMOs. No, I'm talking about the real bloodsuckers, the people who line their pockets with American healthcare dollars and don't actually do anything to promote or support patient care--people who, in fact, weaken the entire system and put our patients in jeopardy.

There are plenty of barnacles on the hull of US healthcare, but two groups deserve special attention. I don't think I'll get any argument from most people on the first genus of tapeworms that should be in our crosshairs: malpractice lawyers.

Now, from my tone, you might prematurely surmise that I'm hostile to all malpractice lawyers, or that I think the medical malpractice tort system is a bad thing in and of itself.

So, just to be sure there's no mistake, that nobody misconstrues what I'm saying here, let me just clarify by saying that you would be absolutely right. That's exactly what I'm saying.

This is a destructive, malignant, greed-based industry that has been capitalizing on human suffering and sucking the life out of our health care system for quite long enough. The entire enterprise deserves to leave skid marks on the bowl. Our medical malpractice tort system does notimprove the quality of care, does not justly redress errors, has been a principle driver of increased waste and costs, and has poisoned the art of clinical decision-making almost beyond recognition. Other, more rational, more effective, and more just alternatives are readily at hand to mete out justice and provide compensation and care for injured patients. These are not opinions, they are facts, and they constrain malpractice attorneys, as a class, with a direct and categorical moral duty to find a way to serve the public interest rather than harm it, as they are doing now. They can do this by evolving into homeothermic chordates and working on new methods for just and proportionate patient redress, or by devoting their skills to another branch of the justice system. Or they can remain in an evolutionary cul-de-sac, in which case we should force them to trade in their pin stripes and Porsches for a nice shelter and a soup kitchen. Either will do. If health care reform puts thousands of ambulance chasers (and malpractice insurers, and professional expert witnesses, and various and sundry other vermin) out of business, I will not shed one bitter tear. They're bloodsuckers. They deserve to be eradicated.

The second superfamily of parasites that needs to be exterminated make up that vast, vile and suffocating biofilm known as the Health Insurance Industry. It's time to don hazmat suits and go to work on these guys with a pair of pliers and a blowtorch.

A lot of sturm und drang has erupted over the now-moribund prospect of a Public Insurance Option, much of it having to do with such a public program's ability to insure more Americans at less cost by undercutting premium margins and exploiting unfair advantages (such as lower marketing costs) over for-profit insurance. Horrors! These “unfair advantages,” it is said, would gradually suck all the oxygen out of the insurance market, and ultimately put HMOs and other private health insurers out of business.

Really? Wow. When can we get started?

Let's review the physiology and life cycle of a typical member of the species insurances profitales parasiticus, shall we? This loathsome creature spawns in that celebrated, dog-eat-dog, Darwinian space known as the Market, which is a great ecosystem for predators and even for wary herbivores, but a really shitty environment for sick people. Once it has affixed to a host (also known as a policyholder), it will feed on premiums until the host sickens, is injured, or is weakened by lack of employment. At that time, the worm detaches and scurries away as fast as possible, to search for another victim while its decimated erstwhile host is consumed by the various scavengers and saprophytes of the Market (and the malpractice tort system—an excellent example of synergistic parasitism).

That's it. That's how this whole system works. For-profit insurers collect premiums from policyholders. That's their blood meal. If they can keep it in their belly, they get nice and fat and rich. And the only way they get to keep it is by limiting or, better yet, denying compensation when somebody gets sick. Think about that: they've already got your money. The fundamental incentives of the free market mandate that theykeep as much of it as possible. As private corporations, it is in fact their duty to their stockholders to keep as much of it as possible--no matter how sick you are.

There is just no getting around it: anybody who has private health insurance places their insurance company in an immediate fiduciary conflict of interest the minute they get sick or injured. That's because the duty to compensate the patient's care is at direct odds with the duty to maximize profits. And that's how we end up with a system like the one we have now--a system in which the insurance marketplace is supposed to provide coverage, but the overriding economic incentives of the insurance marketplace are to deny or limit care. It's perverse. It's immoral. It's evil.

Of course, if Congress cared whether something was perverse, immoral or evil, we'd be living in a different world. Instead, let's focus on the fact that this system doesn't work, that it leaves millions without access, and that it's also stupid and wasteful, because it means that billions of dollars a year are spent lining the pockets of an industry that doesn't actually provide health care--people who actually deny health care for a living.

It's so simple. Don't give healthcare money people to don't do healthcare. What's so hard about that?

Why do we put up with a system that’s dysfunctional and wasteful and immoral, just because it makes a lot of people insanely rich and powerful?

Oh. Yeah, right. Never mind, don't answer that. I'm off to buy another Mega-Millions ticket.

Turkey, Tinea and a Touch of Death

2009-04-28T12:57:00.000-07:00

The Rapid Care clinic hasn’t opened yet, and the acute care mods are beginning to feel like the protracted combat sequence at the end of Children of Men. Yet another patient pops up on my congested list: “scalp rash x 3 mo.”

Unbelievable, I think to myself. Who could possibly think that a scalp rash was an emergency? After 3 months? And what person not at death’s door would come to the ED on a beautiful spring day like this, the first warm day in what seems an eon?

My resident is tied up with a complex lac. That’s okay–on the face of it, this doesn’t look like a teaching case. When I enter the module, I am confronted by an obese, anxious lady with a rip-roaring case of tinea capitis that I diagnose from across the room.

Tinea. Pilfered web image. Not my patient. HIPAA is no fuckin' joke.

I manage a smile that is marginal at best, and squelch my impatience with this silly lady by reminding myself that this case is likely to be quick. Diagnose, treat, street, and back to the “real” patients.

“Hi,” I say, and introduce myself. “I’m one of the emergency doctors.”

She looks me in the eye, and there’s a hint of terror in her expression. “Doctor, I just want to know if I’m okay. I don’t want no aneurysm or cancer.”

Huh? I’m closer now, and I’m 100% certain that this is tinea.

“Um…no,” I tell her, a bit bemused. “That’s not…cancer.” I immediately double-check myself and look again. I squint at it to see if I can make it look like cancer. Nope. That’s tinea.

“I had cancer,” she tells me. “I had cervical cancer.They almost didn’t catch it in time.”

Not only am I sure that this thing on her scalp isn’t cancer, I’m absolutely positive that it isn’t cervical cancer.

“No,” I tell her. “It’s just tinea.”

The unfamiliar word frightens her. Her eyes get wide. “What’s that?“

“It’s a fungus. It’s just ringworm. We can clear it up.”

She starts to relax. “It’s not an aneurysm, either?” Her mother, as it turns out, had an aneurysm, something in her head that killed her. She’s heard that they’re hereditary.

“No, that’s not an aneurysm, I’m sure.”

She grimaces and shakes her head. “I just want to know if I’m okay.”

“I have to ask,” I tell her. “If you were that worried about it, why didn’t you come in earlier?”

She looks at her feet and nods, a sort of silent mea culpa. “I know,” she says. “Stupid.”

Uneducated, I think, but not stupid. By now I’m starting to forget that this lady’s appearance in my ED is cramping my style, messin’ up my rhythm. She’s gone from being a treat-n-street to a person. It’s a humbling moment, of the kind that come–or should come–quite often in emergency practice. There’s no such thing as a good slow emergency doc, but sometimes we do need to slow down a bit just to remember why we’re here. I sit next to her. “No, it’s not stupid,” I say.

“I was just scared. I thought it was cancer. I mean, not really, but I thought it might be.”

I’m suddenly awake to what’s going on. This lady–not particularly knowledgeable, and with limited resources at her disposal–has been trying for three months to work up the time, energy and, most of all, the courage to come down here and just find out whether she’s okay…or if maybe she’s going to die.

Because, you see, she’s had brushes with death before. Unlike many of our younger patients, convinced of their own indestructibility, she’s got the age, the experience, the scars and the innate wisdom to know and fear her own mortality. She watched her mom die young of some mysterious thing called an aneurysm, which had something to do with her head, a genetic demon that might possess her as well. And she herself had to fend off a cancer that had come for her. Now she thought another monster was stalking her, and after three months of hiding from it she’s worked up the fortitude to come in and find out just how bad it is.

She just wanted to know that she was okay.

You and I are the same, I think, and at that moment she is the most important patient in the module.

Let me back up before any of you Bozos think I’m getting all soft and cuddly on you. Not likely. But about three months ago, I did have an interesting experience.

I started my shift at 1pm. It was the standard Mod 4 “afternoon overflow” shift. In all, my residents and I saw some thirty patients over the next ten hours. I had two very long codes during the shift, and most of our patients were complex, difficult, bizarre, drunk and demanding. It was a typical inner-city ED shift. I ate almost nothing, and drank far too much coffee.

At about 1130 pm, after my module had closed to new patients, I came to realize that I had not been taking very good care of a patient who had arrived many hours earlier. I was attempting to correct the deficiencies in my care and was having some difficulty getting the overworked nurses to recognize that he was sicker than I had thought. By midnight, my orders for additional fluids and repeat vital signs had not been carried out. My request to ICU that they admit him had also not been received favorably. All, ultimately, my fault; if I had made the relatively elementary recognition of his need for care hours earlier, I wouldn’t have been playing catch-up.

I stood at the bedside of my patient, painfully aware of the untimeliness and deficiency of my care–not an unusual circumstance for any emergency physician, certainly not for me. I was using my sergeant voice, imploring the staff to hop-to. I was upset with them, with ICU, and mostly with msyelf. And of course, I was exhausted, some 15 hours after rising, some 11 hours after starting shift. I suddenly felt flushed, which for an instant I attributed to my dissatisfaction with the situation and the dismay of letting my patient down. I have experienced this before, this sudden reddening and warming, the adrenal blush that accompanies stress in the ER. Flushing gave way to a sense of profound weakness and fatigue and a sort of vertigo. “I need to eat that sandwich I brought for lunch,” I thought. “I need to sit down and eat.”

Then I was in a dream, looking at a faraway TV screen displaying the faces of my colleagues arrayed in a circle. Then I was inside the screen, and I was in pain, and I fought back against them, and they were holding me to the floor. The Man With The Red Shoes, Dr. Phil, was shouting at me. It took some time to understand what he was saying, that I had passed out, fallen, and struck my head. Now he was flushed and upset, as were my other co-workers. I had really frightened them. Soon I was on a backboard and then on a gurney, with O’s in the nose and an IV and monitor leads on my chest. I was a patient in my own module.

The story became more clear as time went by and they filled me in. I had told one of my favorite nurses, in what she called a strange, sing-song voice, in a very automatic and rehearsed way, to do several things she had already done. “I need him on a monitor.” He was on a monitor. “I need him to get fluids.” He was receiving fluids by then. “We need to prioritize.” I remember saying none of this.

Then I went straight back, like a felled tree, and my head made a resounding crack that, allowing for some exaggeration from my excitable coworkers, was allegedly heard throughout our department. There was apparently some “Smurfication” of my complexion, and I had that empty, blinkless stare we don’t like to see in patients. The nurse could not find a pulse, probably because of profound bradycardia, and CPR was initiated. I woke up some thirty seconds into this code, physically combative, apparently with the words “Get the fuck up off me.” I do not recall that, either. I do recall that my head and neck hurt, and my first quasi-lucid thought was to confirm to myself that I could wiggle my toes, extend my thumbs, shrug my shoulders, exercise my ocular muscles in all planes, and squeeze my own butthole. This I did. A relatively sophisticated clinical self-evaluation, at a moment when I could not recall my own birthday or phone number when asked.

I was scared.

I needed to know if I was okay.

But my ED workup was negative, my colleagues and coworkers were wonderful, and an overnight in the CCU yielded little besides a bill. Cardiology told me to set up an appointment for a perfusion stress and an event monitor. I went home. (And no, contrary to all the rumors I’ve heard, I did not sign out AMA.)

Ultimately, I believe this was an incident of little practical consequence, though it was a tad embarrassing. But I am awe-struck at how how precipitously and inexorably my sensibilities were taken from me. One moment I was suddenly overwhelmed with fatigue and dizziness, with barely an instant to reflect upon a sandwich before consciousness left me. If it had been a lethal arrhythmia, my last worldly thoughts would have been of honey-roasted turkey and Swiss cheese. I did not register what was about to happen to me, much less did I have time to marshal what would have been an ineffective defense, or even a clever parting quip. My last words would have been “We need to prioritize.” Better, I suppose, than “I know what I’m doing, dear,” or “I need my diaper changed,” but hardly worthy of a tombstone.

Just that quickly, death might have tapped me on the shoulder and taken me. Of course, I have been aware of this possibility for some time, but to experience this small taste of the Reaper’s power, so palpably and vividly, can really change one’s outlook.

Doctors tend to think of themselves as fighters against pain and disease and death. And I for one always fancied that I had a better personal chance against untimely death than the average Joe, simply by virtue of being an ED doc and in relatively good health. Of course I should have known better, and now I realize, as never before, that death need not face me like a combatant and grapple with me for my life. He can slip up behind me and cut my throat without a moment’s warning, whereupon I have barely enough time to register my own confusion before consciousness is gone. We are fighters, yes, but he is not. He will brook no opposition, and has no compunction about exercising his office without warning or trial.

My patient with tinea knows this better than I did just a short time ago, because she has had her own brushes with death. And she knows something else, too. She knows that death and disease are mysterious, even to doctors. Sure, she may not know how to tell tinea capitis from a skin cancer. But neither can my colleagues in the ED and in the cardiology clinic tell me why I zonked out in the middle of the module that night.

So even after my CT and my EKG and my serial troponins and my other labs all came back 5/5, I, the big smart academic MD-PhD, was left with the same question that haunts my patient: Am I OK? Thereafter, every twinge of minor thoracic pain, every brief instant of fatigue or dizziness, every caffeine-induced palpitation made me wonder: Am I OK?

Two weeks after my episode, the resident who had been working with me that night approached me and asked me how my perfusion stress and event monitor had turned out.

“Well,” I said. “I…uh…”

Her eyes got wide. “No. You didn’t get them!”

“Well, now, look…”

“You didn’t follow up! I don’t believe it. You didn’t follow up!” She’s gaping at me.

Another resident overhears this. “What the fuck, Dog?”

I am well-rebuked. Yes, I feel dumb. For two weeks I’ve been wondering: Am I okay? Do I have a renegade coronary? Some weird channelopathy that doesn’t show up on a cardiogram? Some insidious valvulopathy? Sick sinus? Epilepsy? Glioma? Oh, fuck–do I have brain cancer? Oh yeah. That’s it. It’s brain cancer. Or a valvulopathy. Or it’s a brain cancer and a valvulopathy. Do they go together? I bet they do. I bet there’s some weird syndrome of brain cancer, valvulopathy and syncope. A classic triad. Probably named after Quincke.

The only difference between me and my patient is that I can dream up far uglier and more ridiculous scenarios to explain my mysterious condition than than she can, by virtue of my training. But I’m apparently no more capable than she is of getting out from under the bed to do battle with these phantasms. It takes two weeks and a tongue-lashing from a couple of residents to get me to pick up the phone and make an appointment in cardiology clinic.

I put my hand on my patient’s shoulder. “It’s not cancer and it’s not an aneursym,” I tell her. “It’s just a fungus infection. It can be a little stubborn, but I can give you some medicine that should clear it up.”

She takes a deep breath and holds it. I can read her mind. She wants to hear the words.

“You’re okay.”

I can see the tension go out of her shoulders and her jaw muscles. She lets out a huge sigh and smiles. I’ve given her a reprieve from a sentence that we all must face eventually, a sentence that, in her mind’s eye, has hung over her head for weeks. I’m pretty sure I can help her tinea, but looking at her, I think that with two words I’ve already relieved more suffering in this one “non-teaching case” than I have all month. Something akin to the relief I felt when my cardiologist showed me the negative results of my perfusion stress, or when my three-week event monitor (what a pain in the ass!) came back negative. My world was exceptionally vivid after that clinic visit, my coffee quite bitter and delicious. I suspect my patient will find the fresh air outside today more pleasant than most of us would, the sunshine just that much more golden.

I shake my patient’s hand and go to write her prescription. You and I are the same, I think, feeling more like a doctor than I have all morning. But we’re okay.

Bronze Fu: Thoughts Upon Re-Reading the Iliad

2009-02-10T06:30:00.000-08:00

I read the Iliad during high school, of course, just like you. Of course, at the time, the tale of an epic clash between two great Aegean powers was not high on my list of priorities. I was far more concerned with the way Sandy Britton's butt looked in those super-tight hip-hugger jeans, whether I would be able to score some Thai stick for the party at Tom's house, and was my hair long enough or too long?

Alas, as they say, youth is wasted on the young. Many great books were spoon-fed to me during my high school years, often to no avail. Those that were administered to me by William Ferrell, the single greatest teacher of my life, were the best-digested and best-remembered, but the Iliad was not one of them. In any case, I have felt a need, for some time now, to embark upon a program of remedial reading, to refresh my appreciation of those classics that were in unfair competition with Sandy's butt, or which I never read at all.

To that end, I recently purchased Books That Made History; Books That Will Change Your Life from the The Teaching Company. This program is hosted by one Rufus Fears, who as it turns out is no Bill Ferrell. But at least the set gives me a program to follow in my remedial reading project, and, in Fears, somebody to yell at for being full of it (a nice bonus, that).

The series starts with Bonhoeffer's Letters and Papers from Prison, a worthy if overstuffed anthology which I have read and digested and upon which I may post eventually. Second is the Iliad, that great lay of war and folly and supernatural meddling. This book, books about the book, the Marvel comic (yeah, I'm not too proud), Julian Jayne's insane take on Homer, some supplementary materials about Mycenaean civilization, and a couple of relevant vids took up a fair amount of my scant free time over the holidays and month of January. Like all good books, the Iliad will consume as much of you as you will allow.

Fears, in his rambling, characteristically ostentatious discourse on the book, avers that the Iliad is about clear-cut right and clear-cut wrong, prescriptions for living, etc. I have noticed that Rufus sees in all great works the rejection of moral relativism, and the Iliad is no different for him. I think he misses the point entirely. For me, the Iliad is alive with the tension between civilization and barbarity, arrogance and duty, reason and rage. This tension is manifest in the stark contrast and conflict between Achilles and Hector, and also within Achilles himself, who in the Iliad makes a journey between these extremes, from rage and arrogance to duty and humanity. His "First Rage," instigated by Agammemnon's seizure of Briseis, precipitates his reckless withdrawl from the Greek host, and brings disaster upon his countrymen. Upon the death of Patroclos, Achilles' First Rage is resolved, and he rejoins the Argives, not to aid his countrymen, but to vent his Second Rage. This Second Rage is directed ultimately upon the slain corpse of Hector, who personifies civilization and duty. Achilles' treatment of Hector's body is beyond the pale, an affront even to the gods, who send Priam to Achilles' tent under Herme's guidance. There Achilles is moved to pity, and in that pity he rejoins the company of human beings and releases Hector to his father.

"Thus did they celebrate the funeral of Hector, tamer of horses," reads the last line of Homer's epic. As near as I can tell, it is the only time in the Iliad that Hector is called "tamer of horses." Achilles is the horse Hector has tamed, even in death.

There's much more here, of course. There's honor, murder, betrayal, sex, a midnight spy mission, Olympian slapstick, and crazy-outrageous battle scenes, rendered in clinical detail. Homer seems to have been a frustrated forensic pathologist, and is at pains to fill us in on exactly which organs and body cavities that spear went through before so-and-so fell to the ground, bereft of life.

Hanging over everything, mixing the pot, is the power of the gods, and their actions give the lie to Fears' take on Homer. The gods of the Iliad are not powers of absolute good or evil; they are not transcendental in any way, except their longevity and raw power. The gods of the Iliad are arbitrary, foolish, arrogant, selfish, petty, lusty, shockingly gullible, and in some ways more human than their subjects. They command human fealty only through their power, not as arbiters of justice or reason, and they are the prime movers of the all the bloodshed, destruction and cruel fuckery of the Trojan War.

Read the Iliad, and please take note that every single episode of import is catalyzed by Olympian meddling. The plague of arrows that ultimately precipitates Agamemmnon's seizure of Briseis, leading to the First Rage of Achilles, upon which all else follows. That rogue arrow which causes so much consternation among the Greeks. Agammemnon's dream-impulse to assault the walls of Troy. The exploits of Diomedes. The fall of Patroclos. The return of Hector's courage after the chase around the walls. Finally, the god Hermes guides Priam to the tent of Achilles, whereupon the Homeric world's greatest killer is moved to pity, and reclaims some small measure of humanity and civilization.

The most consequential decisions of the Iliad are literally not made by men, but by gods, who manifest themselves in very concrete ways to the Achaean and Trojan warriors, either in the guise of their fellows, or whispering into their minds to goad them on, fooling them with cheap tricks, vain promises or exhortations to honor.

Indeed, it is this strange hallucinatory tone that furnished the psychologist Julian Jaynes with much fodder for his 1970s tome, The Origin of Consciousness in the Breakdown of the Bicameral Mind. In the Jaynesian model, Bronze Age humans were not truly conscious in the modern sense of the word, but instead possessed a "bicameral mind," the biological substrate of which was a right-hemisphere "God" and a left-hemisphere "Man." As is the case today, most of their cognitive machinations were subconscious, but when the right brain came out with a decision or an analysis, verbally presented via the corpus callosum to the left hemisphere, it was interpreted not as the result of one's own deliberations, but as the utterance of a god, demigod or god-king. In 1982, Charles Hampden-Turner summarized Jaynes' hypothesis nicely in his wonderful overview of neuropsychiatric and philosophical models, Maps of the Mind:

With consciousness so defined [as by Jaynes] we must recognize that in a book like the Iliad (shorn of its later accretions), human beings are not conscious at all! Words are not used metaphorically, but have only their original conrete referents from which consciousness later developed...Jaynes believes that the world of the Iliad, indeed the whole known world of theocratic god-kings prior to about 1500 BC was possessed of a bicameral mind, split in two.... For the most part such minds would operate, learn, think react and retain equilibrium as ours do, unconsciously. But when something unexpected and hence stressful happened, instead of a period of intense consciousness, with inner deliberation and argument, bicameral man would receive a god-like command from his right hemisphere instructing him to act, as Zeus ordered Agammemnon to attack before the walls of Troy. This is essentially similar to the reported auditory hallucinations in schizophrenia, which are frequently accurate comments on events, and which Jaynes regards as partial relapses to an earlier state of ancestral bicamerality....

You have to admit that an idea like this is, on the one hand, profoundly evocative and interesting, and on the other hand deeply loopy. Nevertheless, Jaynes has earned a certain degree of respectability over the last three decades, although I suspect that if there's anything to his hypothesis it has less to do with any material difference between Bronze Age and Silicon Age neurobiology. Rather, I suspect it has more to do with interim changes in consensus reality and the modern concept of identity and self, which may well be a post-Bronze Age innovation.

Once you're done reading Homer and Jaynes, you'll doubtless be horny for more ancillary reading. No need to jones, there's plenty to indulge you. Maybe you're one of those people who can't really appreciate a story until it's been told in comic form. For you there's Marvel's graphic novel adaptation of the Iliad, which you will find agreeably...visual, if a little stiff, and remarkably faithful to the original. Of course, it's been condensed to fit into graphic novel format, although that's not hard when you account for Homer's epic two-page metaphors, recitations of lineage, detailed recountings of eating and drinking and divers comings and goings--not to mention the frequent and discursive musings of Nestor.

Of course, no story can be digested by the non-bicameral, 21st-century mind until it's been committed to celluloid. Wolfgang Petersen did his part to correct this deficiency with his 2004 film Troy, which has the same title as Homer's epic (Iliad means "pertaining to Ilium," and Ilium means Troy), but not exactly the same story. The movie boasts admirable production values and performances--most especially Peter O'Toole's moving potrayal of Priam. But Homer's themes are muddied by a dumbed-down script, and the absence of the gods assures that Troy not only lacks the atmosphere of the original, but also the Olympian motivations that drive the characters. Without Zeus and Athena and Poseidon, who are Achilles and Menelaus and Agamemmnon? Just psycopathic whackos with spears.

All that being said, Peterson's depiction of the epic clash between Hector and Achilles, while significantly more drawn-out than the original, has got to be the best Bronze Fu on celluloid.

If its film you want to supplant your reading of Homer, I recommend that you instead spend some time with the 1970 adaptation of Eurypides' The Trojan Women, starring Katherin Hepburn, Brian Blessed, Genevieve Bujold, and Vanessa Redgrave. Well after the deaths of Hector and Achilles, after Odysseus has breached the walls of Troy with deception, the women and wains of Troy stand among the ruins to accept their fate. Homer has shown us spectacular deeds, honor and glory in the clash of great armies, the acts of heroes inspiring, and inspired by, the gods themselves. Eurypides turns the page on Homer, and shows us the eternal aftermath of war, the suffering and cruelty that reverberate long after Achilles' rage is spent.

2009-01-20T17:27:00.000-08:00

Over at TNR, John Judis races to be the first to diss the inaugural address, calling it a "hodgepodge," and the talkbackers pile on to take sides.

I have to say, Judis completely lost me on this one. The speech was beautifully delivered, spoke to our better angels, and had a rational progression:

Hi, everybody, we are in some deep shit. Who cares who's to blame. We're Americans, and we can dig out, if everybody grabs a shovel and if we get past all those false choices, all that either-or, blue-vs-red, GOP-vs-Dem, Free Market-or- Socialism-and-no-in-between bullshit. Here's a few high points of my domestic and foreign policy agendas everybody knows already. Let's finish up with inspiration, exhortations to courage, and calls to service and responsibility, all liberally (if you'll forgive) sprinkled with totally appropriate historical allusions, confidence in the American spirit, and praise of inclusion and tolerance. So let's get to work. God bless us, every one, cuz we're gonna need it.

It was an incantation, calling forth the archetypes that lie in the collective unconscious of America, and an eloquent affirmation that those powers belong to us all.

That's what I heard. Then I went back to work.

So for today the speech was just right.

What will be the ultimate verdict on the inaugural address of Barack Hussein Obama? I don't know. But I do know that verdict won't be passed down by Mr. John Judis. History will judge this speech and, as always, She will do it in Her own good time.

So take a chill pill, everybody, and try to savor the moment. No matter what happens tomorrow, today was a good day.

2008-11-04T19:05:00.001-08:00

Rove Calls the Election...

2008-11-03T18:55:00.000-08:00

.for Barack Obama, 338 to 200.

Sullydog's 2008 EV Prediction

2008-11-02T17:43:00.000-08:00

Here's my prediction, based on the most recent polling. My research materials included 538.com, electoral-vote.com, rcp, pollster.com, cnn and msnbc. Obama wins the Kerry states + FL, IA, NM, CO, NV, NC and VA. He does NOT win OH, IN, MO, MT, AZ (gimme a break), ND or any contested district in NE.

Pennsylvania, McCain and Pickett's Charge

2008-10-21T15:02:00.000-07:00

Herewith my own take on the new McCain Pennsylvania "strategy" that Mike Crowley brought up here, reconsidered here, and further eludes to here. This sums it up:

The go-north strategy assumes McCain thinks he can hold Virginia. But, even though VA wasn't named in yesterday's CNN story about states at least one McCain insider considers "gone," his chances there are looking awfully bleak, even if you assume a surprise Bradley effect. If Virginia's gone, too, then PA really is McCain's last shot.

I don't get it.

Looking at the polling in PA, it just doesn't seem like a good play. PA has gone blue for the last 4 elections, and Obama is ahead there by double digits--as much as 12 points in some polls. McCain hasn't been ahead in PA in a single poll since at least May. Even when McCain was surging, he wasn't winning PA.

And poster Mike, responding to Crowley's "reconsidered" post, makes nice point:

It's looking more like the primary where Plouffe's ground game built too many firewalls before Hillary invaded a state. Plus, McCain knows the $150 million in October combined with the flood of new donors means Obama began his version of Rove's final 72 hours when polls opened. McCain can burn his time and money in PA for the rest of the week but by early next week he'll know if Obama has already done the job on the ground. At that point he might save a close down ballot race but won't reclaim any state where 1/3 of the vote is locked in and it shows he's several points behind.

So I have to ask myself: is this a hail-Mary, a head-fake, or a kamikaze mission? Somebody help me out here. I agree that taking PA maybe wins McCain the election, VA or no VA--assuming Obama loses all the other battlegrounds: OH and MO and NV and FL and NC, which is not a done deal by any means. (I don't include CO as a battleground anymore; I think it's solid blue in 2008.)

Okay, sure, in that scenario PA wins McCain the election--but that's kind of like R. E. Lee saying, ca March 1865, that taking the Eastern Seaboard brings victory to the Confederacy. Absolutely true, and totally irrelevant, since Lee had no hope of capturing the Eastern Seaboard. And McCain, to my eye, has next to no hope of capturing PA.

Am I just fucked in the head, here? Because I really don't get it. Somebody please help me out, because PA for McCain looks like Pickett's Charge to me.

Powell Endorses....

2008-10-19T08:45:00.000-07:00

...Barack Obama.

It's not exactly an original thought that Obama probably locked up this endorsement some time ago, and kept Powell in pocket until the best time.

This was, undoubtedly, the best time, kicking McCain while he's down.

What will be the effect of this endorsement? It's hard to imaging that it's anything but great news for Barack, but what is the magnitude of this vector? I think there may be competing factors here. On the one hand, it further cements American's greater comfort with the idea of Obama as CiC. Notwithstanding the tarnishing of his rep by the UN presentation, Powell still commands great respect in this country. The endorsement also emphasizes that Obama is surrounding himself with, and listening to, some very smart, mainstream political, economic and foreign policy titans. OTOH, there may be an undercurrent of "Powell endorsed Obama cuz he's black." My guess is this view would be held predominantly by people who wouldn't vote for Obama anyway.

So, yeah, net positive for Obama. But the magnitude? The effect on the polls, and the election? Anybody's guess.

I Just LOVE Electoral Maps

2008-10-18T09:45:00.000-07:00

It's a sickness, really. Maybe it's because, perversely, they reinforce the election-as-warfare concept. When you talk about McCain barely holding on south of the Mason-Dixon line, and how Obama has probably taken Virginia and is making inroads in Ohio...jeez, it sounds like something you'd hear in a Ken Burns documentary on the Civil War.

Anyway, I love electoral maps. So here's another cool one to add to your bookmarks. Zogby's interactive electoral map is pretty nifty (not to mention very, very blue right now). CLick on a state and get a succinct analysis of where things stand.

"Racism is a Luxury"

2008-10-18T09:25:00.000-07:00

Priceless post from Sean Quinnn at fivethirtyeight.com. They've been tramping across the country, looking at battlegrounds and safe states alike, checking out the electorate, reporting on the ground games (or lack thereof), as part of their "Road to 270" series. Great stuff. But yesterday's installment, on Pennsylvania, takes the cake. Must-read graf:

So a canvasser goes to a woman's door in Washington, Pennsylvania. Knocks. Woman answers. Knocker asks who she's planning to vote for. She isn't sure, has to ask her husband who she's voting for. Husband is off in another room watching some game. Canvasser hears him yell back, "We're votin' for the n***er!"

Woman turns back to canvasser, and says brightly and matter of factly: "We're voting for the n***er."

My country, 'tis of thee...

Washington Post Endorses Obama

2008-10-17T11:39:00.001-07:00

And I think they pretty much nail the rationale. Read it here.

Craven

2008-10-14T18:52:00.000-07:00

Over on the Stump, Noam Scheiber alerts us to Matt Dowd's comments on McCain's "craven" VEEP pick.

"Craven" is the best way to describe it.

This, for me, should be the gist of it for the electorate. In a desperate bid to solidify his base and pander to the XX half of the electorate, McCain put the entire nation at risk by choosing Sarah Palin.

"Country first," indeed.

"Honor," indeed.

Yes, McCain has bragged of being "the biggest deregulator you ever saw." His economic "plans" are disjointed and ad hoc at best. Unlike the thin gruel of the Ayers association, McCain's Keating Five involvement shows that he's been on the wrong side of issues that have tremendous currency. Even now, he continues to repackage the utter failure that is Reagonomics for the electorate. His obstinate subscription to the Bush foreign policy is a huge black eye, and his repeated references to some undefined, mystical "Victory" in Iraq hints at a disturbing Quixotic neurosis. His campaign has been disorganized, flat-footed, tactical (if you'll forgive) rather than strategic, and in some ways more malevant even than the Rove playbook. Last week his campaign had to pull back from incitations to violence.

And the man is fairly starting to dodder.

But forget all that. Palin alone disqualifies McCain, at the most fundamental level, to be Commander in Chief. In a crunch, at a time of crisis, he put himself ahead of his country, and showed that he could not be trusted to make decisions for the nation. Not only should he not be President, he should retire from public life altogether, in disgrace.

McCain is a man I once admired. Now I am ashamed of him.

Hitchens Endorses Obama...

2008-10-14T03:31:00.000-07:00

...with his usual rabid eloquence.

Obama Campaign Leaks Prep Video

2008-10-09T18:22:00.000-07:00

I don't know who this kid is, but if the election turns out the way I think it just might, he could have a very bright future. You gotta see this.

"It's Too Late" (for McCain)

2008-10-09T17:16:00.000-07:00

Uttered by Joe Scarborough on Colbert. Wow.

More, Scarborogough lays out quite an indictment of the GOP and the Bush Administration. I'll try to get the video clip.

Ladies and Gentlemen, John McCain Has Left The Building!

2008-10-07T21:28:00.001-07:00

There seems to be an emerging kerfluffle about how Barack and Michelle hung around to press the flesh in the town hall, while John and Cindy had already got out of Dodge.

Well, okay.

More to the point, the insta-polls show that Obama ran away with it.

Even some conservatives think that, maybe, This Was It. There's just one more debate. If the game hasn't changed by then, it's hard to see how the last debate, so close to the election, changes the course of the cyclone.

A very good night for Obama, on style and politics, and to my eye on points as well. Things are starting to solidify for him.

G'night.

Buchannan Speaks

2008-10-07T19:59:00.000-07:00

The foxy old bigoted warhorse, whom my wife and I suspect actually lives in television studios, is nevertheless a very smart political observor, and he's the first besides the anchors to make the call on MSNBC. There are caveats peppered throughout his assessment, and he thinks both Obama and, particularly, McCain, helped themselves tonight. But then there's this summation:

"...[Obama] surivived the second battle and....he's nine points ahead." (Emphasis Buchannan's.)

Update: here's TNR's assessment--"Obama Crushes McCain." Partisan? You betcha. I don't think anybody got "crushed."

First Impression

2008-10-07T19:48:00.001-07:00

No blowouts, no game changers. Kind of a yawner, actually. If there were any watch-checking moments or major gaffes, I didn't catch them. I think the healthcare responsibility-vs.-right thing may blow up, and not to Mac's benefit. And there was absolutely no mention, not even tangentially, of Ayers, Wright or Keating. And Obama never brought up the issue of McCain's recent pivot to slime.

It seems to me, and yes I'm biased, but I feel as if Obama kept hammering on stuff that's been working for him, and McCain kept hammering on stuff that...hasn't been working for him.

McCain definitely looks like a plausible president, to be sure, and he looks the old warrior, but old he looks, and there's still some anger simmering under the surface. Obama looks confident, relaxed, poised, smart, presidential and....tall. Is Kennedy-esque going too far?

There seemed to be an undercurrent of Rope-a-Dope here. McCain kept swinging, but Obama never really responded in kind. He just kept sidestepping and head-bobbing.

So far in the debates, the insta-polls from the networks have predicted the responses in the polls. We'll see how it goes this time. But I don't see a game changer here. The way things stand, McCain needs a blowout. Obama just needs to maintain.

So I doubt that McCain saved his campaign tonite.

What Don't You Know, and How Will You Learn It?

2008-10-07T19:42:00.001-07:00

Question is too clever by half, but Obama's immediate response is affecting: "My wife could tell you all about that." Says "country" when he means to say "world." Talks about the American Dream, and its accelerated decrepitude in the last 8 years. We can't fix it if we keep doing the same things (implicit: as McCain will do.)

With his last words, McCain raises the specter of the unknown, and talks about how he was raised by a single mom, too, because dad was at sea. Trying to project toughness and patriotism. "I'm asking the American people to give me one more opportunity."

And then, an interesting use of the past tense: "The great honor of my life was always to put my country first."

Have We Got Israel's Back?

2008-10-07T19:37:00.000-07:00

McCain's approach to the questioner is very effective. Aaaaaannnnnd we're back to the sit-down-without-preconditions non-issue. Iranian nukes are bad.

"My friend." Buvez, mes amis.

What About Vlad?

2008-10-07T19:30:00.000-07:00

Mac: "We're not gonna have another cold war." Really? Then he immediately raises the spectre of a successor to the old Soviet Union. The "I saw three letters, KGB" line, again. Waiting for him to nail Obama on his "wrong" call on Georgia. Doesn't come yet.

O, you want to send money to Georgia? Excuse me. Obama is a little too halting in this answer. And he gives us another I-told-you-so riff vis-a-vis Georgia, probably trying to pre-empt Mac from correcting his lapse above.

Brokaw: "Is Russia an evil empire? Yes or no?"

Obama: Not a yes or no answer.
McCain: "Maybe."

Mac never does cover his missed opportunity with the Georgia issue on this question.

Should We Go After Al-Qaeda in Pakistan?

2008-10-07T19:16:00.000-07:00

Obama calls his questioner by name, and makes the question about Mess-O-Potamia. His answer is smart and rational. In the first debate, Obama was able to use this issue to sound tougher on terrorism than McCain. Now he's trying to do it again.

Mac: "Teddy Roosevelt is my hero." Then he Walks Softly and Talks a Big Stick. Again, I don't think this argument works against Obama, regardless of its merits, because he's trying to rebut Obama's "I will go in there and kill Bin Laden" argument. Oh, and I visited Waziristan. Yes, John, we know.

Kefluffle about followups.

O: "Nobody called for the invasion of Pakistan." Calls McCain on some of his own rash statements, and puts him on the defensive.

"I'll get Osama my friends." Open wide, puppies.

Bottom line short answer to the question, should we go after Al-Qaeda in Pakistan?

O: "Yes."
M: "I've been to Waziristan."

So far, I haven't seen a game-changer.

Can We Afford to Be the World's Cop?

2008-10-07T19:07:00.001-07:00

Mr. Elliott asks McCain if our economic crisis will affect our ability to act as a peacekeeper in the world. McCain doesn't answer him by name.

"My Friends." Don't argue baby. Just swallow.

Mac: We're number one, and you can't put a price on that. I've got the experience. I've got the judgement. Wait for it: Obama fought the surge.

Yep. There it is. In all fairness, not a bad answer.

"My friend." Suck it down, bro.

Obama: A reprise on the "you were wrong" refrain. And then he ties Iraq neatly to the economy. Yes, we are number one...but we won't be if we keep hemorrhaging cash. Nice answer.

A fair enunciation of the Obama doctrine.

McCain elides the question to attack Obama again. How in the hell does this help him? This is the same stuff they hashed out in the first debate to no salutary effect for McCain. "YOu need a cool hand at the tiller." And, um, we should think that's you, after the last few weeks? But McCain's answer is still not half-bad, even though it probably echoes Obama's a little more than Steve Schmidt would like.

Health Care as a Commodity

2008-10-07T18:57:00.001-07:00

Obama needs to address this questioner by name and he doesn't. But his answer is smart.

Sometimes obama's speech patterns are pretty halting. I'm waiting for him to go to his "Mac will tax your coverage" meme.

McCain's "Obama will fine you" for not getting/providing healthcare is a good jibe. Will it stick?

McCain says healthcare is a "responsibility" not a right. That...is the wrong answer. Will Obama take that opening?

"It should be a right for every American." And he brings his Mom into it.

Obama makes a medical error on asthma but makes a good stab at McCain on S-Chip. Overall a good answer.

What Will You Do On The Environment?

2008-10-07T18:48:00.000-07:00

Almost all the questions so far are on the economy, and even this one mentions it.

"My friends." Glug, glug, glug.

"What's the best way of fixing it? Nuclear power." And Mac dismisses Obama's caveat that nukes must be safe. McCain's riffing on the power of the American workforce pretty effectively.

O: "If we can create a new energy economy we can create 5 million new jobs."

Counters on Johnny's nukes allegation effectively. Nails Mac to his Senate record.

"We can't drill our way out of the crisis."

On the followup: should be have a Manhattan-type project or a garage project?

Kinduv a bogus either-or question.

McCain's attitude is suddenly snarky and preening, at least to my eye.

Doesn't McCain's ending remark about Obama's support of storage and reproceesing of fuel make Obama's point for him?

Entitlement Programs

2008-10-07T18:43:00.000-07:00

Obama quickly makes this about the tax code, so that he can respond to McCain's last thrust and also elaborate on his tax plan. Almost a hint of outrage when he talks about McCain's tax plan--"unfair."

"My friends." Drink, damn you.

Back to bipartisanship, and how Obama doesn't fight with his party. Again.

McCain wants a commission on Medicare.

McCain looks awfully scrunched up. But he prowls across the stage.

"My friends." Drink!

What Sacrifices Will You Make?

2008-10-07T18:33:00.000-07:00

McCain goes off on earmarks again. And then this insane idea of a spending freeze again. Obama needs to go after this.

Obama's answer is, to my ear, pretty damn smart. I'm not going to cut your programs; I'm going to ask you to cut your energy expenditure, and I'm going to ask Big Energy to step up to the plate.

"He wants to raise taxes." McCain compares Obama to Hoover. Ouch. Obama wants to kill small business. He's gonna steal your jobs!

Obama is chomping at the bit to respond...

How Can We Trust You Guys?

2008-10-07T18:21:00.000-07:00

Are Obama's numbers on the deficit correct?

Both candidates are trying to put this on the kitchen table. Obama may be doing better, but only a little.

McCain answers with his record on bipartisanship, and how Obama has never been a maverick. Always Look For The Liberal Label. And we're on the earmarks again. I think his "look at our records" gambit may set O up for a response. Let's see...

McCain cops out on the priorities followup. Then pivots to the bipartisanship riff again. Build nuke plants, create jobs. Actually, he doesn't sound half-bad on energy. Two more "my friends" shots.

Obama, on the other hand answers the question "just like a family has to prioritize." And, oh, by the way, it's about your gas tank, your health care...

Oh, and back to that "look at records" bit...excellent riposte by Obama.

Brokaw bitching about time. Fuck, dude, you're the moderator.

How Does the Bailout Help?

2008-10-07T18:14:00.001-07:00

McCain sez it's not a bailout, it's a rescue. Why in the world does he want to bring up his campaign suspension again? Not a good idea.

Here comes the Freddie-Fannie association...and the word "crony." Unbelievable.

McCain is promising to buy your mortgage. This is his Drama moment tonight. The enormity of it is just beginning to dawn on me. It may be the biggest pander of all time.

Obama: I told ya so (in re deregulation). Decent response to McCain's fannie-freddie jibe.

Brokaw bogusely tries to put words in Obama's mouth. Obama waves him off.

McCain pushing this huge mortgage pander again. Obama's name was not on some letter. Okay. So? Now some smart riffing on the strenght of American workers.

Liveblogging the Debate

2008-10-07T18:04:00.000-07:00

Slightly different approach tonight than in the last one; I'll go by questions. And I'm hoping my good pal Steve Eley will be able to join us.

First up on Brokaw's agenda, of course, is the economy. Obama goes first, and immediately calls the questioner by name and immediately pins it to the Middle Class, and pins it on Bush, the GOP and McCain. Starts talking specifics, and pivots quickly to his middle class tax cut, projects to keep people in their jobs, energy, etc. Ties it all together. Decent answer.

McCain immediately tries to make it a needle on the Town Hall "issue." He goes to the deficit and reforms again...not sure that's a winner for him. He wants the treasury to buy up bad mortgages?!? Talk about doubling down. If you're drinking a shot for every "my friends," you just took your first hit.

McCain initially has no idea who to put in the Sec of Treasury post. Pulls out Warren Buffet and Meg Whitman. Okay. Hope OBama's thought about the answer to this question...yep, Buffet again, but Obama's quickly moving to empathizing with the struggling voters.

And Now For Something Completely Different

2008-10-07T10:00:00.001-07:00

Back to science, which is what this blog is supposed to be partly about. We've been fiddling around, trying to get a working rat hypothermia model that's clinically relevant. We think we've got it now, and yesterday we tried our new system, the Arctic Rat (TM) suit, while monitoring both rectal temperature (body core temperature) and temporal muscle temperature ( a surrogate for brain temperature) in a rat under general anesthesia. Here are the results.

A couple of notes. The temperature is reported, obviously, in deg C. The x-axis time points are every five minutes, so the experiment went from 0 to 90 minutes. Target temp was 32 deg C, which is as far as we intend to go with the current study. That's equivalent to 89.6 deg F, or 9 degrees F lower than body temp. The top two curves are core temp and temporal muscle temp, and they correlate very nicely. The third curve down is the ambient temp (yeah, it's hot down here). The next curve is tank temperature; this is the temperature of coolant we used. The bottom curve is the difference between the two temps, which got tighter quickly and stayed that way; it was always under our max acceptable diff of 2 deg C.

What I'm happiest about is that we were able to get to our target temp quickly and then keep it pretty much on target with minimal adjustments of tank temperature. This model is almost ready for prime time. We have to tweak our sedation method and make sure the core and temporalis temperatures correlate with brain temperature, but once all that's done we're In Like Flynn. Hypothermia for brain ischemia is hot, and we're eager to explore not only its therapeutic benefit but also just exactly what it does at the molecular level.

How To Go From Straight-Talkin' War Hero To Grampa Simpson In Six Months Flat

2008-10-07T09:19:00.000-07:00

There was a time when, as an Arizona native, I admired my state's junior senator, John McCain. I saw him as a true American, a moderate, and yes, as a straight talker. In 2000, when he ran against W, I was seriously ambivalent. On the one hand, I wanted W to win the nomination, because I thought he was a lightweight (boy was I wrong). OTOH, I wanted Mac to win, because I thought if a Republican were to win the White House, Mac wouldn't be too bad, and please Jesus oh please don't let W run the country (boy, was I right).

All that is gone now. McCain has shown us his true colors. Here's a nice piece from John Heileman at the New Yorker on how McCain blew it.

"...a very aggressive last 30 days"

2008-10-04T09:17:00.000-07:00

Interesting piece from Liz Sidoti of the Associated Press, putting the last 30 days of the race into perspective.

Some Republicans close to McCain's campaign fret in private that Obama may be pulling away for good; others aren't so pessimistic. But there's unanimity in this; McCain has dwindling chances to regain momentum in the face of stiff headwinds, and the upcoming debates are critical.

The conclusion that follows for McCain and the GOP is clear. Time to go scorched earth and start lobbing mustard gas:

GOP operatives say the goal is to undercut Obama, likely by raising questions about his associations with convict Antoin "Tony" Rezko, a former Obama top fundraiser, and Bill Ayers, a founder of a 1960s radical group.

"We're looking at a very aggressive last 30 days of turning the page on this financial crisis and getting back to discussing Mr. Obama's aggressively liberal record and how he will be too risky for Americans," senior adviser Greg Strimple told reporters Thursday.

Don ponchos and gas masks. Fix bayonets. It's about to get ugly.

---------------

Update: See also this from Pollster.com.

Biden v. Palin: Preliminary Polls

2008-10-02T20:19:00.000-07:00

I can't believe these results. I figured if Palin showed up and didn't self-immolate, the "soft bigotry of low expectations" would give her the prize with the voters. But here's a preliminary CBS poll of undecideds:

Forty-six percent of the uncommitted voters surveyed say Democrat Joe Biden won the debate, compared to 21 percent for Republican Sarah Palin. Thirty-three percent said it was a tie.

Eighteen percent of previously uncommitted percent say they are now committed to the Obama-Biden ticket. Ten percent say they are now committed to McCain-Palin. Seventy-one percent are still uncommitted.

Both candidates improved their overall image tonight. Fifty-three percent of those surveyed say they now have a better impression of Biden. Five percent say they have a worse opinion of the Delaware senator, while 42 percent say they debate did not change their opinion.

Fifty-five percent say they now have a better opinion of Palin. Fourteen percent say they have a worse opinion, while 30 percent say their opinion hasn't changed.

After the debate, 66 percent see Palin as knowledgeable about important issues – up from 43 percent before the debate. But Biden still has the advantage on this – 98 percent saw him as knowledgeable after the debate. That figure was 79 percent before the debate.

Two thoughts: either this is completely off the wall, or undecided voters actually saw the same debate I did, and judged it not on the basis of expectations but on the actual issues.

538 is reporting similar numbers from CNN. Stand by.

Blogging the Debate

2008-10-02T18:14:00.001-07:00

A semi-masturbatory stream-of-consciousness exercise in solo debate watching:

On the first question, about the bailout, Palin's answer is rehearsed, but clear and well-delivered. On the very next question, Biden gives a quick answer about bipartisanship and then pivots to attack McCain. Palin's response is, again, canned, but not half-bad. Pretty good, actually. If she keeps this up she's gonna make a lot of people on the right very happy.

Palin is talking directly to Joe Six Pack.

Biden looks a little somber. So far he's limiting his attacks to John McCain, effectively ignoring Palin.

...Until now. "The governor did not answer about deregulation."

Now we're on taxes. Biden's answer is effective and to the point. Palin responds with Biden's "paying taxes is patriotic" gaffe. OTOH, she seems to be referring to her notes. But she's knows she's doing well, and it shows.

But Biden's doing well to. On the McCain's health care tax, he's talking right to Middle America, and effectively.

On "what will you give up," Biden gives a very brief token answer then effectively elides the issue and makes it about McCain's economic plan. Palin isn't anywhere near answering the question, but instead makes it about her reformer issue and attacks Obama. Ifill calls her on it. Palin's answer is effusive, but pretty lame on substance.

As of right now, I think Palin has more than cleared the low bar set for her by expectations going into the debate.

On climate change, Sarah starts to babble just a bit.

Biden looks at his notes too, but his riposte on cliate change is solid. Sarah Palin says she doesn't want to argue about the cause, just fix it. How, asks Biden, can you fix it if you don't know what's causing it.

On energy, Palin is certainly holding her own.

Biden just said "same sex marriage." Oops. Palin pounces. But I think the exchange diffuses to nobody's particular benefit.

"Your plan is a white flag of surrender in Iraq." Ow. Let's see how Biden responds. He'd better. Nope. Maybe indirectly. We'll see how that plays out in the spin.

Palin: "nuke-yoo-lar." Heh heh.

This won't be a blowout for either side. Looks like it's gonna be a tie, and that goes to Palin.

Argument on Afghanistan works well for Palin, although not against Biden.

Not sure how Biden's passion on Darfur will play with the electorate.

Biden's getting wordier.

Still, if it were anybody but Palin up there, I think Biden would be widely considered to have performed a crushing victory. Won't play that way, though.

On the VP question, both of them get back to the treasured middle class voter.

"There you go again."

On VP as subject to the executive, Palin is seriously babbling. Biden schools her.

Biden suddenly chokes up. Very affecting. Suddenly Palin's response seems cold in comparison.

I'm getting seriously tired of Palin's "lifted" Reagan quips. And if I hear "maverick" one more time....

Right on cue, Biden skewers the "maverick" myth, and makes a moving appeal to the Middle Class at the same time. Beautiful.

I can't escape this impression:

Palin: cutesy-poo. Well-prepared.
Biden: passionate. Steeped in the issues.

Now, stand by for the spin. I note that a Palin gaffe has been reported already: she botched the name of the commander in Afghanistan.

If The Real Thing Don't Do The Trick You Better Make Up Something Quick

2008-10-02T17:31:00.000-07:00

Ann Wilson will always be a babe to me, no matter how roughly time treats her. But I have to say she hasn't been this sexy in a long time.

Michigan Just Lost More Jobs

2008-10-02T12:33:00.000-07:00

McCain just yanked his campaign from the Wolverine State.

There's absolutely no way to read this as anything but an ominous development for Johnny Mac. Presumably, new numbers in FL, OH, NV and NC are scaring the living bejeezus out of him, and rightly so. To be real, I think Obama has had MI in the bag for a couple weeks at least--and judging by the last several election cycles, where MI toyed with being a swing state but always broke for the Dem, it was probably never really in play to start with. Smarter for a desperate McCain campaign to try to deprive Obama of VA, NV, NH--and maybe Colorado, although I think there is probably no Rocky Mountain High for McCain in November. And McCain simply cannot afford for FL to be in play. So this was a smart move for him, although definitely not one they wanted to make. McCain's recent "life's not fair" remark is another sign of the grim mood on the Straight Talk Depress. It's not over till it's over, and I still think the 3N threat is a very real one to Obama, but McCain had better get some damn good news, and real soon. It's crunch time.

Breath of "Fresh Air" on Wall Street

2008-10-01T09:57:00.000-07:00

Wow. Busy blogging day today. Guess I'm trying to make up for lost time.

Today's interview by Terry Gross is Must Listening*...and a much more eloquent and informed take on the issues I addressed in a recent post.

*Audio will be available soon.

Don't Mean A Thing If You Ain't Got That Swing

2008-10-01T08:27:00.000-07:00

There's much good news for Obama (and precious little for McCain) in today's Quinnipiac swing state analysis.

Update: The Q-polls have been absorbed by Nate Silver and there's a rare early post at 538. Today's projection shows Obama winning about 85% of 10,000 simulation runs, with 51.4% of the popular vote, and carrying the Kerry States + OH, FL, NV, NM and CO, for a total of 336 EVs. Is that what November 4th will look like? Don't believe it for a minute. All elections tighten. This one will do the same--only more so, I predict--and I just can't believe that Obama will carry OH and FL. The 3N vote will be strong in those states.

But right now, Obama doesn't need OH and FL. This is the best Obama has looked on 538 all year (RCP and Electoral-vote.com give similar strong showings on their electoral maps). Going into October, this is definitely his election to lose.

Fair and Balanced Pennsylvania Coffee Shop Banana Split

2008-10-01T07:55:00.000-07:00

Fuckin' hilarious.

Living History

2008-09-30T12:27:00.000-07:00

Maybe we're all overblowing this, but it's hard to escape the sense that we are all sitting on the fault line, shaken by the perhaps the largest economic discontinuity in history. It may not be the most catastrophic--I think there's reason to believe our economic and civil institutions are more robust than in 1929--but certainly the largest. And it won't just be an economic discontinuity. I believe it may very well mark a major political realignment.

There is now pretty good polling data to demonstrate that, at least for the time being, Americans are overwhelmingly laying the blame for the banking meltdown at the feet of the GOP. And by GOP, read "market conservatives." And that blame is well-laid, I think, because, of course, "market conservatives" have been anything but since the sainted Ronald Reagan. Reagan began an era of aggressive deregulation, delirious deficit spending and regressive taxation that reached a vicious and insane crescendo during the Bush presidency. Progressives, like myself, have been waiting for almost thirty years for the other shoe to drop.

Given the poll numbers I linked to above, not to mention Barack Obama's current command of the electoral college, it looks like Democrats will have to clean up the mess, as they did under FDR. No candidate entering October with a lead in the polls has lost since 1960, with the exception of Carter, who was arguably an outlier because of a fresh military fiasco in Iran and a post Oct-1 debate. And so the economic discontinuity triggers a political discontinuity, as it must.

But I wouldn't look to a return of FDR. What we see will be something...different. Oh, sure, on the surface, it will have some similarities to the New Deal. I, for one, don't believe that Obama, a man who must be acutely aware of his place in history, will allow a gazillion-dollar tab for the bailout to clip his wings. I think he'll double down, and invest in technology, infrastructure, education and health care to a degree that will make techno-progressives swoon and paleoconservatives pop aneurysms like a child pops bubble-wrap.

But there'll be more to it than that. There'll be a new regime of regulation and government involvement in the economy--government investment in the economy. I just don't see how Congress, short of a full-scale and catastrophic Republican mutiny, can seal this breach without buying up huge amounts of equity in banks and mortgages. The government is going to be a shareholder--which means we'll all be shareholders. "The last nail in Ronald Reagan's coffin," as some GOP congressman put it. Aye, and good riddance, I say.

What kind of New New Deal will Obama and a Democratic Congress shape from this catastrophe? I don't know, because they don't know, and there'll be more than a little of Making It Up As They Go Along involved.

The biggest implication for what we're living through right now may be this: the greatest economic discontinuity in human history is taking place contemporaneously with the biggest ecological discontinuity--global climate change, loss of habitat, and a global mass extinction event. Will the shape of what emerges from the meltdown and the new ascendancy of progressivism (if, in fact, it materializes) be for the good or ill of our species and world?

Who the fuck knows? Fasten your seatbelts, because right now we're flying dead stick.

America, Religion and the Debates

2008-09-30T12:08:00.000-07:00

So, you thought you didn't hear anything about religion at the first debate? Wrong. Check out this fascinating post by Bill Bishop over at Slate.

Among other things, this just underlies my ever-growing conviction that old divides may scar over, but they never really go away. Look at the last few electoral college maps, and then look at the Civil War.

Or, if you really want an object lesson in how long historical patterns can persist, look at the full extent of the Roman Empire:

....then look at Cold War Europe:

Historical and cultural divides, once established, really tend to persist.

I Knew It!

2008-09-28T08:51:00.000-07:00

That hypercircumcised peckerhead Steve Schmidt (McCain campaign manager) is on Meet the Press claiming that McCain engineered the bailout package. What a piece of shit.

Conspicuous by His Absence

2008-09-27T21:41:00.000-07:00

Bunch of old white people just got up in front of some cameras on the hill to announce the largest government spewage of cash in history. Don't know what the details are yet, but everybody showed up to crow about a resolution. Pelosi, Frank, Paulson, Shumer, Blunt, everybody.

Everybody, that is, except John McCain. I've been concerned that McCain would try to take credit for whatever emerged and crow that his leadership (the Chinese fire drill of the last few days) was what made it happen. But he's nowhere to be seen, and his name was not mentioned. Indeed, it seems that if anybody got credit for the breakthrough, it was Pelosi.

Debate One: Tie Goes to Obama

2008-09-27T09:54:00.000-07:00

I've been MIA again, yes I know, and despite my promises to the contrary. For all two of you who might drop in on this from time to time, my apologies. I don't know what to do except just pick up where I left off.

Political junkie that I am, I was up all night watching the pregame, the debate, and the postmortem. (I'm working a shift next week, the killer Mod 4, 1PM to post-midnight, please-fuck-me-deeper-harder shift, so I'll have to catch Biden-v-Bambi on TiVo). Bottom line: both men missed opportunities, and it ended in a draw. And a draw goes to Obama.

But that's understating it a bit, isn't it? This was, nominally at least, the foreign policy debate, and it was the last bar for Obama to hurdle in the Can-He-Be-CiC department. McCain, conversely, really, really needed to show the country that Obama was unqualified to be Commander in Chief.

That's right, he needed to show it. Not tell it. This is a critical distinction for people who write, say, science fiction and other less noble forms of literature. "Show, don't tell," is a key mantra in the liturgy of the effective storyteller. McCain kept telling us that Obama "doesn't understand." At the same time Obama kept showing us that, well, yeah, he does understand foreign policy, maybe even better than John "Bomb Iran" McCain. During the foreign policy debate he was able to fluidly spout enough facts to give voters the impression he knew what he was talking about, look more hawkish on killing Bin Laden than McCain, and appear reasonable, cautious and presidential.

Obama didn't just demonstrate his own fluency in fp, he was also able to go after McCain. Obama's litany of "you told us x about Iraq, and you were wrong" was one of the top sound bites of the night.
But he got as good as he gave. To my eye, Obama clearly lost the exchange over diplomacy--even though any thinking voter has to conclude he's right on the issue, McCain had the upper hand on the quip-o-meter at the end of this skirmish. But overall, Obama impressed me on the foreign policy side of the debate, and should have easily cleared the CiC bar with most voters. That's a triumph, and a major missed opportunity for McCain.

On the economic end of the debate, McCain fared better, but only in a negative sense, by steering the discussion away from the meltdown-bailout issue to his obsession with earmarks and spending. That kept Obama from connecting as fully as he wanted to with bread-and-butter issues--but it kept McCain away from the kitchen table, too. In fact, while Obama took as many opportunities as he could to talk about working Americans and the middle class, McCain never uttered the words--an "issue" that's getting plenty of attention on the airwaves, blogs and campaign trail today. Obama looked Too Cool for School on this front end of the debate, when he needed to be warmer and less professorial. Cool is great for the fp debate, and he had it there, but on the economy Obama needs more of that old Clinton bite the lip and feel your pain. He didn't have it. So the economy debate goes, marginally to McCain, for keeping O off his game. But it's a pyrrhic victory. And Obama has two more chances to wrangle Mac on the economy. My guess is the Professor won't make the same mistakes next time.

Before I went to bed, the insta-polls all seemed to be giving the debate to Obama, and by much larger margins than I would have guessed. On points, I thought it was a tie, or maybe McCain, although on style I thought it was all Obama. Obama was dignified, articulate, engaging, relaxed, commanding and, well, presidential. McCain was scrunched-up, prickly, snarky, and refused to look at his opponent, which seems to have given many viewers (including this one) the impression that debating this upstart was somehow beneath him. Doesn't play. Still, a 15-point spread in the insta-polls and focus groups for Obama? I have to think that this is a gmisch of sampling bias (probably 2-5 points right there) and low expectations for Obama on the foreign policy end.

Bottom line: neither guy self-immolated or knocked out the other. And that's a good night for Obama, if not a great one.

Open Mike Night: Political Commentators Caught Doing Political Commentary

2008-09-03T15:20:00.001-07:00

Chuck Todd thought he was cutting to some governor. Oops. Instead, he and his round-table, including conservative commentator Peggy Noonan and former McCainiac Mike Murphy, got caught on an open mike, unwittingly telling the world what they really think. Below the clip there's a transcipt, courtesy of my new heroes LAT and Andy on the discussion board at Five Thirty-Eight. This is priceless.

Noonan: [Can't hear since Todd (who is still on air) is talking over her]

Murphy: Um, you know, because, I come out of the blue swing state governor world. Engler, Whitman, Tommy Thompson, Mitt Romney, Jeb Bush, I mean, and these guys, this is all how you win a Texas race, just run it up, and it's not gonna work.

Noonan: It's Over.

Murphy: Still, McCain can give a version of the Lieberman speech and do himself some good.

Todd: [can't really tell what he says, but he mentions something about "insulting to Kay Baily Hutchinson]

Noonan: [says something I can't understand]

Todd: She's never looked comfortable up there..

Murphy: Oh, fuck that.

Todd: I mean, is she really the most qualified woman they can obtain?

Noonan: The most qualified? No. I think they went for this, excuse me, political bullshit about narratives...[couldn't hear the end of it]

Todd: Yeah, but what's a narrative?

Murphy: I totally agree.

Noonan: Every time Republicans do that, because that's not where they live and it's not what they're good at, they blow it.

Murphy: You know what's the worst thing about it, the greatest of McCain is no cynicism, and..

Murphy and Todd together: This is cynical.

Todd: And as you called it, gimmicky.

Sarah Palin, Secessionist

2008-09-02T08:53:00.000-07:00

Below is a video of GOP VP candidate Sarah Palin addressing the convention.

No, not the GOP convention. The AIP convention.

The Alaska Independence Party was founded in the seventies by Joe Vogler, who argued that the referendum that brought Alaska into the Union was unlawful, and that Alaska could and should secede from the United States. Volger died in 1993, and his last wish was that he be buried in Canada, rather than under American rule. The party has remained a player in Alaska politics, and many elements within the party continue to espouse secession. They've also toyed with the idea of becoming part of Canada. The party's website features this prominent quote from Vogler:

"I'm an Alaskan, not an American. I've got no use for America or her damned institutions."

This is the party to which Palin belonged in the 90s, with whom she still cultivates good relations, and whose convention Palin is addressing from the Governor's Office, telling them to "keep up the good work."

Talk about Country First.

Hero No More

2008-09-01T12:13:00.001-07:00

I've seen any number of conservative shills try to make lemonade out of the catastrophically irresponsible selection of Sarah Palin as a running mate by John McCain, by casting it as a gutsy move, doing what Obama didn't have the courage to do--putting a woman on the ticket.

Bullshit. There's nothing ballsy about the selection of Sarah Palin. Quite the opposite. It was rank cowardice.

By all accounts, McCain was looking at a number of Midwestern GOP governors for the VP slot. But he was particularly inclined to tap indpendent Joe Lieberman. But as Lieberman--a bold, courageous and potentially game-changing choice--seemed more possible, religious conservatives and none other than Karl Rove began the arm-twisting. There was talk of a floor fight.

And so McCain relented, and went down yet another notch in my estimation. Then he descended even further when, in a desperate and flagrant pander, he tapped a dangerously unprepared neophyte to be a heartbeat away from the presidency.

So it boils down to this:

The Hanoi Hilton couldn't break John McCain.

But Karl Rove did.

I'm Back...

2008-09-01T12:08:00.000-07:00

It's been a crazy month, but a good one--long hours in the lab, and lots of kerfluffle to take care of.

In the lab, it's been eventful. We've ditched our implantable "Refrig-a-RAT-or" and developed a "Cool Suit" for our hypothermia model. Our focal ischemia model is coming together in preparation for the ISIS-funded investigation of our combination therapy approach.

And...we had another paper accepted! More on this later.

How I Mounted Goldie, Saved My Partner Lori, and Sniffed Out the People's Justice

2008-08-04T06:10:00.000-07:00

That's the title of my most recent story sale to Escape Pod. I haven't talked about EP here, but if you haven't checked it out, you should. EP is a weekly science fiction podcast produced by Steve Eley, a world-class Good Guy. It's a very successful program, and Steve regularly brings his listeners audio versions of stories from the likes of Mike Resnick, Cory Doctorow, Robert Silverberg, Elizabeth Bear, Paul DiFilipo and Isaac Asimov. When Steve was just starting out, he came to me for the very first story he ever published, a nasty little piece called "Imperial." It's a source of unending pride to me that Steve launched his popular enterprise with one of my stories, and that he continues to let me do reviews, even though I'm very irregular about it and my reviews frequently result in flame wars. (For a taste, go to EP and check out the response to my review of "300.")

The reading on "Goldie" is better than I could have hoped for. Steve and Dr. Jennifer Bowie captured exactly what I was trying to do, and both story and reading have been getting great reviews on the EP blog (which can be a pretty tough crowd).

Hispanics Breaking for Obama?

2008-07-24T09:38:00.000-07:00

This is potentially huge. I've always suspected that Obama's support among Hispanics would be very soft at best, especially given McCain's history with this demographic and his conscientious wooing of the Hispanic vote. This poll is just a snapshot, but in conjunction with other data I've seen, and especially given Obama's performance with Hispanics during the primaries, this could speall real heartache for McCain.

Obama Rocks--World Tour 08

2008-07-24T05:53:00.001-07:00

I've been off the blog for a few weeks--a very busy time indeed. I got funded for a project to investigate combination therapy for stroke (yes! at last!), and I'm working with my colleagues to launch it. And I'm busy trying to get a fellowship grant out the door, along with a new animal research protocol. Excuses, excuses, yes I know. But at least you can't say I'm not using my time well.

What to say about Obama's cruise through the Old World? This shot puts him in the CiC chair, next to Petraeus, looking like buddies.

Oh, and while he was doing photo-ops with the troops, Maliki endorsed his withdrawl plan, which led one political operative with ties to the McCain campaign to surmise: "we're fucked."

And this article, which must be giving McCain a bit of dyspepsia right now, just appeared in Time, which means it will be read in dens, kitchens, lavatories and waiting rooms from now to November.

Over at fivethirtyeight, the model has narrowed Obama's lead, although the polls are volatile and the simulation still shows him winning 58% of the time with 292 EVs. But I would look for a bounce after Obama's world tour. If it materializes, Obama can take some assurance that he's gone a long way to clearing the CiC bar for the presidency, which means he can probably walk right into the White House. If no post-world-tour bounce materializes, I think that's big trouble for Barack.

Goodbye, You Hateful Little Bag of Pus

2008-07-07T17:30:00.000-07:00

I love Chris Hitchens, not because I always agree with him (I frequently do not), but because he is the most eloquent rabid dog on the planet.

For example, consider his contribution to world's newest political genre, the Jesse Helms Obituary. Compared to others working in this field, Hitchens is Shakespeare. His good-riddance obit is a veritable sonnet. Couldn't have said it better myself. Must reading.

Kanji Flashcards, Grade I

2008-07-04T09:03:00.000-07:00

My first set of video flashcards for Japanese kanji. These are also available on my web page at sullydog.com, along with a lot of other Japanese language study materials.

Good News for the Lab

2008-07-01T09:25:00.001-07:00

Me and my colleagues, Drs Anthony Lagina and Jie Li, have been awarded a grant from the WSU Cardiovascular Research Institute to study combination therapy for focal ischemic stroke. It's a small award, but it will definitely help us launch a project we've long been itching today. This will be a preclinical study, and if the results are positive, it will easily translate into a clinical investigation with patients. We are psyched.

Will Powell Endorse Obama?

2008-07-01T09:22:00.000-07:00

A delicious prospect, to say the least. Here's today's take on the possibility from NPR. Needless to say, whichever way Powell goes, it will be huge, and the fact that it's even possible that Powell would endorse Obama is also huge.

Neither Fishy Nor Foul

2008-06-26T07:05:00.000-07:00

Fun piece by Taegan Goddard at Political Insider on the GOP's failure to package Barack Obama during the primary season:

...it's clear Republicans haven't yet settled on who the man is they are facing in the presidential election.

Sometimes he's part of the country club set, other times he's an outsider with a strange name raised by a hippie mother.

Sometimes he's a Christian with a controversial pastor, other times he's a secretive Muslim.

Sometimes he's the black activist who resents white people, other times he's the Ivy league lawyer who doesn't understand the working man.

Sometimes he's naive to the ways of Washington, other times he's politically ruthless and overly ambitious.

And now it's probably too late. Obama has opted out of public financing, and will have nearly unlimited resources to package himself--and John McCain. The decision puts a stain on Obama's halo, but one that voters are likely to forgive, if they care about it at all.

Meanwhile, McCain's brand is seriously tarnished. A long string of flip-flops have made "Straight Talk" a punch line, and he's still trying to get out from under the Bush III label.

It's a given that Obama will spend a lot of time and money selling himself as a patriot with fresh ideas, while going after McCain's policies. His strategy going forward seems clear.

But which way does McCain go? Having squandered the primary season's opportunities to smoke Obama by characterizing him as an unexperienced country-club Muslim radical black Christian flag-hating terrorist, does McCain now spend his relatively limited resources rehabilitating his own image? It's a viable approach. McCain does have gravitas and experience, and although his maverick image is way overblown, he can point to important differences between himself and the GOP Dads.

Or does he focus on building distrust of Obama? Hasn't worked so far, but the secret of the Big Lie is to repeat it incessantly until the hypnotic mantra takes hold.

Or--here's a thought--does he engage Obama on the issues? McCain has legitimate differences with Obama, on issues from Iraq to healthcare. Problem is, it's not at all clear that he can simply paint Obama as a radical liberal, given the electorate's current antipathy toward the GOP.

Politically, we're in a brave new world--a favorable season for Democrats in which the nominee is in a position to outspend the GOP nominee by 3-to-1. How do the Republicans play it?

Wow.

2008-06-25T08:12:00.000-07:00

New ad from Oregon senator Gordon Smith extolling the legislative work he's done with Barack Obama.

Yeah, that's right. Smith's a republican.

"They Have To Do That To Remove The Jaw"

2008-06-25T06:00:00.000-07:00

Lost a filling yesterday afternoon, and had to go the dentist. No big deal, right? Quick nerve block, drill out the failed filling and any new decay, pack with amalgam, see ya bye. Right? Except all of a sudden they're talking about root canals and crowns and all other manner of crimes against humanity.

There were a number of technical difficulties. These culminated in an "easy last step" during which they took an acrylic mold of my repaired teeth from which to mold the permanent crowns.

And then they couldn't get it off.

Seriously. It took two hours, a heavy drill bit, a pair of pliers, a load of elbow grease, a cathartic amount of suffering and, eventually, an additional nerve block to get this lump of steadily hardening super-glue out of my poor mouth. They had to destroy the fucking thing to get it off, along with a fair amount of soft tissue on my gum and cheek. And then, of course, they had to cast another one.

So I'm sitting at home today with some pain pills, flashing on this:

I've Just Discovered...

2008-06-25T05:49:00.000-07:00

...Failblog, the clearing house for lolcat-style documentation of human folly:

An essential public service.

Obama Flip-Flops; Decides Not To Be Putz After All

2008-06-25T05:21:00.000-07:00

Everything we hear from the McCain camp on Obama's funding reversal is just a mixture of sour grapes and fear. They know that by opting out of public financing, Obama will have the option of carpet-bombing McCain in the general--as a look at Obama's first ad buy clearly demonstrates.

On the ABC roundtable this week, Matt Dowd tries to make the case that this move will tarnish the Obama brand, and he won't get that much extra juice out of it anyway--Obama would find it difficult to spend the extra moolah during the general. Roberts counters that Obama spends his money very wisely, on a state-of-the-art ground game. Donaldson and Dowd retort that in the states where Obama outspent Hillary...he lost.

That's true, but Donaldson and Down miss the point. In his recent massive ad buy, Obama is targeting states he knows he won't win. I mean, really--Alaska? But as he did with Hillary, Obama can use his money to engage McCain everywhere, and bleed him dry. By opting out of public financing, Obama will have the luxury of forcing McCain to compete in states that should be safely red.

At some point during this exchange, Stephanapoulous notes that Brazile has been very quiet. He calls her out, and she nails it:

"I'm sitting here laughing at people who think that Senator Obama will be harmed by going outside the system."

On the other hand, Dowd makes the most succinct and incisive formulation of the general I've heard so far:

"This is an election that Barack Obama could lose....but John McCain can't win."

Exactly.

Corn Ethanol and The Medical School

2008-06-19T05:44:00.000-07:00

A message from Dr. Robert Mentzer, the Dean of Wayne State's School of Medicine. I don't always see eye-to-eye with my Dean--in fact, more often than not, I don't. But this missive is eloquent, and, I think, right on the money. I reproduce it in its entirety.

Dear Colleagues,

During the month of June, the atmosphere at the School of Medicine is always highly-charged and filled with excitement. There is good reason for this - it is the time when the most recent class of Wayne State medical students graduates. Graduation provides tangible evidence of academic success to both students and faculty and validates that the hard work invested by both was worth it. Our 247 medical and doctoral graduates now embark on the next step of their training in the pursuit of the knowledge that will help them further develop their scientific proficiency while applying their knowledge to the clinical practice of medicine.

The pursuit of excellence in medicine is a noble one. It is important to understand that the road to excellence is not always smooth or straight. There will be conflicts and frustrations imposed by the business imperatives that drive other parts of the healthcare system. As physicians, we must navigate through the potholes and curves associated with such restrictions.

For example, there are politicians and business people who would suggest that the academic model of healthcare which has served the people of our city, our state and our nation so well is outdated. A university-based healthcare model emphasizes translation of education and research into new levels of clinical excellence at the bedside. The newer business models embraced by these advocates would sever the connection between these three inter-related elements of medical science.

There are unintended consequences associated with such a strategy.

According to Rob Norton in the The Concise Encyclopedia of Economics, the law of unintended consequences is that the actions of people -- and especially of government -- always have effects that are unanticipated or "unintended." Norton goes on to say that economists and other scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it.

Said another way by Dubner and Levitt in the NY Times Magazine in January of this year, the law of unintended consequences is what happens when a simple system tries to regulate a complex system. A political system can be simple, and operate with limited information, short time horizons, low feedback, and poor and misaligned incentives. Society, in contrast, is a complex, evolving, high-feedback, incentive-driven system. When a simple system tries to regulate a complex system, there are often unintended consequences.

The law of unintended consequences is at work in the promotion of bio-fuels, especially methanol, as alternative fuel sources. Methanol is derived from corn and water. Because of the strong political push to reduce our dependence on foreign oil, agricultural incentives have been created to sell corn to bio-fuel producers. This increased demand has driven the price of corn higher. The higher corn prices have disadvantaged the food industry and farmers who rely upon corn as feed for livestock. Consequently, food prices are increasing and are likely to continue to rise.

The same sort of myopic thinking is occurring in our state relative to the academic model of healthcare. Dismantling the parts of our university-based model could have unintended consequences for both the quality of healthcare and its availability to people who have few options. It is a course that could change the focus of medicine away from our mission to one driven by deals and dollars. As healthcare organizations, insurance companies and politicians assume greater control over the direction of patient treatment and protocols, the role of the physician as the primary safeguard of care is diminishing. There seems to be a sense that more effort and better care yield less expensive care. The evidence would suggest otherwise. And the stakes are too high to casually turn away from the issues. Politicians are insulated from the outcomes of poor decisions. Physicians have no such luxury.

The oath physicians take at the outset of their careers means that the patient, regardless of ability to pay, regardless of social standing and regardless of age or the extent of disability must receive the same sort of care as others who are more advantaged. At times, this puts physicians in direct conflict with those who wish to make patient care decisions based upon politics or economics. In truth, physicians are the conscience of our system of healthcare. Physicians, not administrators, must make treatment decisions.

Physicians are biomedical scientists with the unique and special gift of using science to help those with disabling illnesses return to productive lives and to alleviate the pain and suffering associated with disease or trauma. It is a special gift and a tremendous responsibility. Meeting this responsibility requires pursuit of excellence on a road that is filled by a vortex of humanity--human needs and human decisions that are often decidedly unscientific.

It is this that makes the challenge of practicing medicine so interesting and so unique. As fascinating as pure biomedical science can be, science without humanity serves no productive purpose.

(Emphasis added.)

Obama: I'm N Ur WSJ, Rockin' Ur Wrld

2008-06-18T17:40:00.000-07:00

Obama goes to enemy territory and gives a interview to the Wall Street Journal.

Here's what I would say: I do believe the tax policies over the last eight years have been badly skewed towards the winners of the global economy. And I do think there is a function for tax policy in making sure that everybody benefits from globalization or at least the benefits and burdens are shared a little more easily. If, as some talk about, we've got a winner-take-all economy where the highly skilled, highly educated are reaping huge rewards and the unskilled or even semi-skilled are getting a much smaller share of the economy, then our tax policies can help cushion some of the blow through providing health care. So if people lose their jobs they're not losing their health care as well. That actually makes a more flexible work force that makes workers more mobile and less resistant to change. If we've got investments in education, that will make us more competitive in the long run. We've got to pay for that like anything else. But it would be a mistake to say I view our tax code only as a distribution question. I also think that our tax code has come to distort a lot of economic decision making so I'd like to see simplification as part of an overall tax agenda.

There's somebody in there.

"I Just Don't Know What To Say."

2008-06-18T04:55:00.000-07:00

On the Diane Rehm show yesterday there was a fascinating discussion of the legal and political ramifications of the Supreme Court's recent decision granting habeus corpus relief to detainees at Guantanamo Bay and elsehwere.

You really should listen to the whole thing, and on balance both sides hold their own. Advantage: supporters of last Thursday's decision. But at 34:51 there begins a discussion with a McCain adviser, Kohri Schake. When Diane presses her on the fundamental contradction between McCain's opposition to the decision and his previous statements about closing Gitmo, Schake blows it spectacularly. Worth listening to.

George Will Scares Me

2008-06-18T03:55:00.000-07:00

Why? Because I so often agree with him these days. This is what Bush hath wrought: the neocons make paleocons like Will look positively progressive. This from today's column:

As the conservative and libertarian Cato Institute argued in its amicus brief in support of the petitioning detainees, habeas, in the context of U.S. constitutional law, "is a separation of powers principle" involving the judicial and executive branches. The latter cannot be the only judge of its own judgment.

Hardly a ringing endorsement of the Unitary Executive.

You can read Will's column--which, by the way, takes McCain to task for his outrageous pronouncements on the Court's recent habeus decision --here.

Diarrhea! Diarrhea!

2008-06-15T07:43:00.000-07:00

I've just updated my website with my most recent lecture to residents and faculty, and so this seems as good a time as any to tell all the thousands of people who don't read my blog that I have a bunch of teaching materials online. You can find my medicine and science-related materials at sullydog.com, under the heading Quantum Meat. There are three kinds of Quantum Meat at my site: Classic Meat (general science articles and presentations, mostly from my days at Neverworlds), Rat Meat (related to my cerebral resuscitation research) and Medical Meat (emergency medicine teaching materials). The most recent lectures on Medical Meat are about diarrhea. I gave a talk on acute diarrheal illness to the residents and faculty in February, and in the course of that presentation mentioned that the approach to diarrhea in AIDS patients was "a whole other lecture."

Great, said the chief resident. When will give us this whole other lecture?

Emergency Medicine Residents are like bottomless pits. They require constant feeding, attention, supervision, love, teaching, pizza and, in my opinion, regular beatings. Apparently, they thrive on potty humor. And when they ask for another lecture you can't say no. Not if you want them to grow up big and strong.

Anyway, here's Diarrhea Part II. It's a powerpoint file, a few Mb, and can be viewed online in Explorer or in Powerpoint. Enjoy.

Fair and Balanced Fox Fires Fairly Unbalanced Fox

2008-06-14T12:01:00.000-07:00

After she suggested that the dap Michelle gave Barack on the night he won the nomination was some sort of super-secret terrorist fist bump (no doubt Al-Qaeda Manchurian double-agent code for: Osama--we're in), E.D. Hill, a member of Fox's Stepford Stable of Distinctly Aryan Anchors and the host of America's Pulse, was forced to apologize. The apology itself is a thing of beauty for its own ugly little genre, neatly associating the word terrorist with Obama by apologizing for...associating the word terrorist with Obama. The "moving right along" moment is also nicely done. And, damn, she looks good doing it, doesn't she?

Apparently, however, neither the conspicuous leg nor the non-apology-apology did the trick--Hill lost her show, but will continue to serve Fox "in a capacity to be determined." I'll just let that one go by. I will say, in all fairness, that I actually think the lady has a point when she pleads that she was just reporting on what others had said, and I'm not sure she deserved to lose her show. I'll also admit that when it comes to Fox, schadenfreude overwhelms my sense of fairness every time. I'm always happy to see Faux step in it.

To celebrate, I offer this:

Enjoy.

If It's Sunday, We'll Be De-Pressed

2008-06-14T10:31:00.000-07:00

I was in the middle of an emergency department shift when I heard of the death of Tim Russert. I took a moment between codes to check cnn.com, just to be sure it was real. A resident, reading over my shoulder, noted that Russert had just returned from Italy (a long and potentially clot-inducing flight), and wondered aloud whether Tim had succumbed to a pulmonary embolus. "Why don't you focus on your own patients?" I snapped. Then I got back to work myself. I was in a foul mood the rest of the night.

Well, it wasn't a massive PE, it was a lethal coronary occlusion, and that just makes it worse, because so often we can save those lives. But Tim's MI apparently resulted in an immediate lethal tachyarrhythmia, and he could not be resuscitated. It is a terrible, unexpected loss, all the more painful because he was clearly so engaged with and excited by Election '08. Tim was living through history, and as James Kirchick has noted, the pity is he won't get to see how it turns out.

Maybe you loved him, maybe you hated him. More probably, like me, you indulged in a little bit of both, depending on who he was talking to and how hard he pressed them (or not). But, love him or hate him, you could not dismiss him. One can argue that the moment Hillary's campaign finally crumpled was when Russert said so.

Men and women of phenomenal power and stature, presidents, pundits, senators and scientists, gladly lined up to sit in his hot seat. Political junkies like me ate it up. I can't remember how many times, watching MSNBC political coverage, I would think, enough with the lightweights already. What does Russert have to say? The man had juice.

Less than 24 hours after his death, it's already a cliche, but there's no other way to say it: Sunday morning just won't be the same. Be at peace, Tim.

It's The Thought That Counts

2008-06-13T08:42:00.000-07:00

You knew this was going to happen: McCain's aging dendrites have become a campaign issue.

In addition to the Race Card, the Gender Card, the Class Card (Green or Platinum), we will henceforth be forced to deal with the Geratol Card, and McCain is already setting the standard for how to play it. If McCain attacks Obama for clinging to failed ideas, or for lacking experience, that's fair game. But Obama must now tiptoe against McCain's doddering political philosophy or risk accusations of ageism.

This is so much bullshit. The fact is that most of McCain's platform is composed of old ideas, ideas that have been particularly prone to displays of incontinence and decrepitude over the last 8 years. On every issue, from tax cuts to Iraq, McCain offers nothing new. And that's fair, because he's conservative, and conservatives aren't about new. Says so, right here on the label.

And that's what's so beautiful about the Age Card. The moment Obama points out that McCain's entire campaign rests on outmoded ideas, or that he's "out of touch" with American people, or that he apparently doesn't realize this-or-that...bam! He's an ageist. Sorry, Obama, the Arizona Senator's ideas are off-limits.

Over at Slate, Chris Beam has a passable piece on what's happening to McCain's cerebral cortex right now. As an exposition on the neurobiology of aging for the lay public, it'll do, although it set of my geek-o-meter a couple of times, and I just couldn't help flashing on the classic pre-election Doonesbury sequence from 1980, "The Mysterious World of Reagan's Brain."

And neurobiology is rather beside the point. I don't care that McCain's brain is old and worn out. It's the ideas inside his brain that are old and worn out. I don't know whether it's his ossified synapses or his ideology that keep him from thinking differently on the economy or Iraq or foreign policy. And frankly, I don't care. The result is the same.

Lithwick Skewers Scalia

2008-06-12T20:26:00.000-07:00

Over at Slate today, Dahlia Lithwick totally obliterates Scalia's hysterical dissent in today's Supreme Court adjudication of Boumediene v. Bush and Al Odah v. US, in which the majority (Kennedy, Souter, Ginsberg, Stevens and Breyer) decided to Let The Terrorists Win by...upholding the Great Writ of Habeus Corpus.

Just a sample:

"...even those who were deemed innocent at Guantanamo are actually guilty in Scalia's mind. And whether or not they ever get to go home, the mere act of providing them with civilian court oversight will surely endanger yet more American lives. For this proposition, Scalia cites the trial of Omar Abdel Rahman in federal court in 1995, in which the names of 200 unindicted conspirators were leaked to Osama Bin Laden. Just to recap, then, everyone at Guantanamo is guilty, and the mere act of trying them will result in more American deaths. This raises the question of what Scalia would do with these prisoners, many of whom have been held for six years without charges. If they can't reasonably be tried or released, it must be a great comfort to believe that they are all killers and terrorists, and no further proof is needed." (Italics added.)

I always love Lithwick, and as Scalia becomes more unhinged, he's an ever-easier and more inviting target. Still, Dahlia is in particularly incisive form today. Read it here.

The Western Tradition

2008-06-12T17:52:00.000-07:00

If you've never seen The Western Tradition, a production of the Annenberg CPB Project from the mid-80's, then you're in for a treat. This program, comprised of 52 half-hour episodes, covers the history of Western Civilization from the prehistoric era (creationists beware!) to just before the fall of the Soviet Union.

For its time, TWT was beautifully produced, and holds up admirably against the dumbed-down mush that prevails on the History Channel or the higher-quality stuff from the Learning Company. When I first aw it, fifteen years ago, I fell in love with it immediately, for its sweeping view of the rise and fall of civilizations, the way it cast the flow of history into the molds forged by geography, economics and, above all, human motivations, for its lush and liberal use of art from every era of history, and its excellent use of animated cartography.

Most of all, I treasure The Western Tradition because of the man who created and presented it, Dr. Eugen Weber. Weber was a Professor and Chairman of the Department of History at UCLA, specializing in fin de siecle France. Born in Romania, he served with the British in India in WWII, after which he studied at Oxford and eventually emigrated to the US. His historical treatises on France turned the field on its head, and are much-beloved by the French, which, if you consider that he was a foreigner, and if you know anything at all about the French, is really quite something. In his presentation of TWT, Weber is clear, engaging, elegant, eloquent, urbane, sparkling, wry, penetrating--and mischievous. He's so frickin' cool that we had to write him and tell him just how cool he was, and his elegant and gracious response to us was even more cool. My wife and I had always hoped he would do a TWT follow-up (a la Sagan) on the post-Soviet world, but he died a little over a year ago at the age of 82, and his obituary documents a life well-lived.
And so, let me present anybody who just might happen to be reading with a priceless link. The Western Tradition is available in its entirety from Annenberg Media for free.

I hope it serves you as entertainment, education, perspective, and as a basis for further study. I hope it brings you as much pleasure as it has given me.

Republic Death Watch

2008-06-10T18:07:00.000-07:00

You can make a pretty good argument that the outlook for the future of our Republic is less than rosy. Me? I'm an optimist. I still think the United States can command a leading economic, geopolitical and military position in this century. But you have to admit that a lot of the signs are bad. Huge swaths of the American electorate believe in angels and ufos, but can't name a single Supreme Court justice. Everybody has an opinion on Iraq, but I've noticed that the most boisterous supporters of the Bush foreign policy can't find Iraq on a map or name a single country that shares an Iraqi border. We're still wringing our hands over race, gender, and sexual orientation, and millions of Americans reject modern science in favor of Palestinian Iron Age creation mythologies. And of course, we fiddle while the planet burns.

The latest sign of a moribund republic? The Senate releases a report that basically comes out and says the Bush Administration lied the American people into a $3 trillion war, and the only pundit who really covers it is...Jon Stewart.

Our Power Grid: In The Wind

2008-06-10T11:54:00.000-07:00

Been off line for a few days because of the system of thunderstorms that stomped through the Midwest over the weekend. We lost power in Sullyland for about 72 hours. This happens with increasing frequency here. We lived in this older, highly wooded area of Farmington Hills for about five years before we ever lost power for more than a few minutes. Now, every time there's a stronger-than-average gust or two, we're off the grid for days, about 3-4 time per year.

This entire uncomfortabe affair raised the same two perennial questions:

1. Why haven't we bought a &^%$#@!&*ing generator yet? (We're on it. Never Again).

2. Why aren't power lines buried? On this one, I'm still reading, but it looks like I'm not the only one asking. Seems that more and more new communities are burying their power lines, but burying old networks is such a huge expense that most municipalities can't afford it. But as weather becomes more volatile, this issue could pick up more steam.

Presidential Debate by Proxy

2008-06-08T08:11:00.000-07:00

Kerry for Obama, Graham for McCain on This Week. I've always thought that Graham was engaging and sharp. Got that homey drawl and them folksy ways, but still one smart feller.

Kerry, on the other hand, just can't help himself: he's arch, plodding, stentorian, and...well, he's Kerry. So I was inclined to just give the match to Graham by default,Tivo past it, and spare myself the pain and disappointment.

But for my money Kerry edged out Graham in spite of being Kerry. Why? It's all in the material, baby. Yes, Kerry was Kerry. Monolithic, monotonic, perfectly coiffed, and vaguely offputting. But he had the goods: he had the Obama plan and the McCain record to work with.

And so did Graham. When you're out there arguing that we need to keep tax cuts for rich people permanent, that our health care system is fine just the way it is, that a 90% voting-with-Bush record is somehow "maverick," and that we need to cut government spending for domestic programs while continuing to blow a gajillion a week in Iraq...well, then even Kerry can kick your ass.

At Long Last

2008-06-07T19:59:00.000-07:00

I'll round out day one of SullyDogBlog with a stab at politics.

Today, Hillary Clinton suspended her campaign and endorsed Barack Obama's candidacy for President. And the whole nation exhales.

Even John McCain had to be getting sick of this. Far from propelling his candidacy, the ongoing primary battle between Barry and Hill showed every sign of toughening Obama up for the general, and was sucking all of the media oxygen away from the dyspneic McCain campaign. Still, it goes without saying that Obama, who has arguably been the inevitable nominee since Wisconsin, couldn't get his campaign rolling until Hill had been dispatched. And for a while there, some on the left (like me--might as well get that out there right now) were worried that Hill just wouldn't die, and would prefer to split her party, cripple Obama, and start planning for 2012 rather than endorse the democratic nominee. Her non-concession concession on Tuesday night felt to some of us like the first step of the descent into that nightmare scenario. Talk about bitter.

Well, it isn't going to happen, and in retrospect, of course, it never would. Hillary Clinton isn't stupid, and she knows what would have happened to her political future in that scenario. Her speech today, while tinged with regret and subtle angling for the second slot, was nevertheless a full-throated endorsement of Obama.

At times, Hill's speech today was almost soaring--especially when she was beseeching her supporters to follow the Obama standard. Gone was the shrill, fingernails-on-a-blackboard timbre of her earlier speechifying. And I couldn't help thinking: what if her speeches leading up to Iowa, New Hampshire, and Super Tuesday had been more like this one? Things might have turned out very differently.

If Hillary can get a sizable enough fraction of her major constituency--working class white women--to follow Obama, and if Obama doesn't stumble, there's a better than even chance, I think, that John McCain is going to have a very bad year.

Stroke me, Stroke me.

2008-06-07T19:25:00.000-07:00

As good a way as any to get this going: announce the publication of my most recent scientific paper. It is, I hope, the end of a fairly fallow period for our lab, the Emergency Medicine Cerebral Resuscitation Laboratory at Wayne State University in Detroit. The paper has to do with the use of insulin in stroke, which is a subject I've been involved with since 1999. In that year, I published work showing that a very high dose of insulin administered to animals after 10 minutes of cardiac arrest could rescue protein synthesis in vulnerable brain cells. But we suspected that wasn't the only good thing insulin did for brains after ischemia. (Ischemia is the condition created when blood flow to an organ is interrupted, as in stroke, cardiac arrest, and heart attack.)

Since that first paper, the stroke research community has learned that one of the key events occuring in vulnerable brain cells during stroke is the release of a protein called cytochrome c from mitochondria. Mitochondria are the powerplants of every cell. And, as is the case elsewhere in life, it's just no good when your powerplant leaks. When mitochondria leak cytochrome c into the rest of cell, it's harmful to their ability to generate power, and leads to the production of free radicals. But more importantly, the leaking of cytochrome c is a self-destruct signal, causing the cell to off itself in a process called apoptosis.

In the new paper, my colleagues and I demonstrate that high-dose insulin administered to animals with brain ischemia prevents the release of cytochrome c and preserves brain cells after transient global brain ischemia, the kind of brain ischemia that can devastate patients resuscitated from even very brief periods of cardiac arrest. We are guessing that this approach has value in stroke and head trauma as well, although that remains to be proven.

You can see the abstract of the paper here.

First Post

2008-06-07T18:54:00.000-07:00

I guess the first thing to say is that this feels vaguely masturbatory.

I am under no illusions. This ain't the Daily Kos. I'll be astonished if anybody bothers to read it at all. But I like to write, and I like to argue, and I like to keep track of what I'm doing, what I'm thinking...and what I'm writing. This isn't so much my blog as it is my Dear Diary.

What will I write about at SullyDogBlog? Stuff that may or may not be of interest to anybody. A lot of it may be completely banal: my garden, my cats, my lunch. Woo hoo. I'll probably do some writing about my work as an emergency physician, especially when it pisses me off, which it does not infrequently. I'll probably write about our progress in the Wayne State University Cerebral Resuscitation Laboratory, which tends to come in fits and starts. I'll write as well about some of my other science interests. And of course what blogger doesn't write about culture, culture wars, the media and politics?

So here goes the blog that might better have been named "Dear Diary Blog," and will probably be kept just as irregularly as I suspect most diaries are. If you're reading this, I can only assume that you are intelligent, discriminating, cosmopolitan, and really, really bored. Welcome.