Denialism Blog

  • Christian Libertarian Wefare Queen

    Shamelessly stolen from Gawker: Brick Fatwa Libertarian Also Gets Fat Government Checks. For what? A preventable disease! Oh, what ever happened to personal responsibility?

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    Illustration: A typical American male libertarian in its natural habitat

  • Surgery

    I have now completed almost a year of surgical internship, and as I’m sure you’ve noticed from my sparse blogging, I’ve had little free time for writing. It’s a shame too because surgery is just so cool.

    Intern year is mostly about learning to manage surgical patients, basically people in varying degrees of health who have the added stress of having surgery recently performed on them. Although the 80-hour workweek and case requirements have pushed more exposure to the operating room into the process than previously existed, it’s still mostly medical management of patients at this stage. We are required to perform at least 750 cases in our 5 years of training. Of these cases, we are required to have exposure to a broad range of different surgeries with certain “defined” major cases counting towards specific quotas. For example, a recent requirement was added that we have at least 85 surgical endoscopy cases, including upper endoscopy and colonoscopies before we graduate. As a result, most of my day is spent dealing with medical issues with post-surgical patients, and if I’m lucky I get to go to the OR and, with an attending of course, learn some simple procedures.

    As your training progresses you take care of more critical patients, with your second year largely devoted to ICU care. You also are involved more extensively in complicated cases, so by the time you’re a third year you are able to help attendings with complex surgical cases, are responsible for evaluating surgical admissions, and begin to manage patients as a chief in some cases. In fourth and fifth years you are in charge of managing whole surgical services and are operating a majority of the time. By fifth year you are a chief, and you should be preparing for eventually operating on your own as an attending or for additional specialty training in a fellowship position.

    My day starts at about 5AM, when I pre-round on patients, collect the data from the previous day for the all-important list, and get signout (news on what happened overnight) from the intern who was on call. By 6AM the chief arrives, you round on the patients, and formulate a plan for the day. You’ve got to discharge patients who have recovered, manage the medical issues of your post-surgical patients, admit new patients and see the new surgical consults. Basically general surgeons get training to be excellent medical doctors who also learn to do surgery.

    The day ends around 5-6PM when you either sign out to the surgeon on call overnight, or take signout from the other services you will cover overnight. Surgical interns usually cover 3 services overnight, so I might be taking care of pediatric patients, plastic patients and urology patients, or emergency surgery, minimally invasive surgery, and surgical oncology patients for 12 hours until the next shift comes in the morning. This means you work for about 30 hours straight, the maximum allowed by the new hours limitations. You address any issues that come up in the night, staff any consults that can’t wait until morning, and every once in a while deal with some terrifying emergency that arises at 2AM. It’s not that bad, but after a full shift you sleep like the dead. Saturday calls are of course the worst, because you start at 6AM on Saturday and don’t go home until around noon the next day, basically losing your whole weekend. Usually we only have to take one Saturday call a month so we don’t lose our minds.

    So that’s why I haven’t been blogging. When not at work I’m usually eating, sleeping, or trying to keep my life in some kind of order. The goal though is to get back into this, to manage my time so we can still talk about medicine, and crankery, and the ever increasing tide of denialist movements. Not to mention TV shows. Anyone else seen Jesse Ventura’s new show? It’s like crank crack. Leave it to Ventura to figure out how to free-base illogical thinking.

  • Healthcare reform

    With the recent victory of this administration in passing health care reform I felt it was time to talk again about the importance of this issue and some of my own experiences in the last year of my surgical training.

    I was, and still am of the belief that reform, whatever form it might take, will be successful as long as we manage to make health care universal. Partly because our system already is universal but defective. No matter if you have insurance or not, if you show up in a hospital with a problem that needs to be addressed, we’ll treat it. We ethically can not turn people away because they lack insurance. People therefore who lack insurance regularly show up in the ER for primary care, or worse, with a problem that could have been addressed by a primary care doc weeks before but now has become so severe they have no choice but to get treatment whether they are insured or not. For instance, I had a patient who arrived in the ER with a gaping, necrotic sore on his cheek. It had started as an abscess, gotten progressively worse, and he tried draining it himself, inadequately, because he was uninsured. Over the course of a week though the sore had eaten through his face until it actually communicated with the inside of his face. The result? Two teams of surgeons later, an ICU stay, and an extensive reconstruction, a 10 dollar problem became who knows? A 50 thousand dollar problem? More?

    We have a choice here. We can have an ethical system that treats people who need care in a thoughtful, sensible fashion, addressing problems through prevention, and appropriate care at the right time. Or we can have a system where people get their primary care in ERs, often showing up long past time their problem becomes critical and inevitably, more expensive. Guess which is less expensive? It’s not necessary to have a single-payer system like Great Britain, Canada or New Zealand. It’s not even necessary to have a public option as countries like the Netherlands demonstrate. You can even have a very generous system that is based on highly-regulated private insurance with subsidization for the poor, as in France or Germany. All of these systems beat ours with regards to cost and performance. What do all these systems have in common but is lacking in ours? It’s simple, they’re universal.
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  • Hiatus!

    Dear Readers, we’ve been completely derelict in maintaining Denialism Blog. Please accept our apologies. Mark is training to be a surgeon, and Chris recently had an enormous baby! We hope to get back blogging soon. Please excuse our absence until life is back in order.

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  • Great Insight into the Randtards in the New Yorker

    Check out this week’s New Yorker for a well-put insight into the Rand-infected mind. Nick Paumgarten writes about John Mackey, CEO of Whole Foods and his attitudes towards unions:

    …His [Mackey’s] disdain for contemporary unionism is ideological, as well as self-serving. Like many who have come before, he says that it was only when he started a business–when he had to meet payroll and deal with government red tape–that his political and economic views, fed on readings of Friedman, Rand, and the Austrians, veered to the right. But there is also a psychological dimension. It derives in large part from a tendency, common among smart people, to presume that everyone in the world either does or should think as he does–to take for granted that people can (or want to) strike his patented balance of enlightenment and self-interest. It sometimes sounds as if he believed that, if every company had him at the helm, there would be no need for unions or health-care reform, and that therefore every company should have someone like him, and that therefore there should be no unions or health-care reform. In other words, because he runs a business a certain way, others will, can, and should, and so the safeguards that have evolved over the generations to protect against human venality–against, say, greedy, bullying bosses–are no longer necessary. The logic is as sound as the presumption is preposterous.

  • Free: The Dismal Deal

    Chris Anderson’s provocative new book, Free: The Future of a Radical Price, argues that in the digital world, “free” pricing is a realistic and normatively good approach to pricing information products. Unlike the physical world of “free” products, which is plagued with fraud and tricks, the properties of the digital world make free actually possible when bits are sold. The physical world is limited, but the digital world is abundant. Businesses can leverage this abundance, and give it away while making money by charging for whatever is still scarce. For instance, software can be given away free while support can be charged for. Stripped down products can be provided free, while expert users will pay for fully-featured products that subsidizes the free.
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  • Want to be a wind up china doll?

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    Take Pristiq. Warning: side effects include becoming a fat wind up doll.

  • This day in Crankery, November 16th

    So who here has actually read the health care bill?. I’ve been devoting a bit of time each week to peruse more and more of it, and while there are endless obstacles to a complete understanding of it (including legalese and the annoying tendency of legislation to contain edits to other bills without including the text of the other bills being edited) it is telling that opponents of the bill are having some difficulty coming up with real criticisms of it. For example, the now infamous death panel fiasco was a willful misunderstanding of a completely wholesome concept, the idea that physicians should be compensated for having end-of-life discussions with patients. It makes sense on multiple levels to reward such discussions. For one, they are hard conversations to have, and without a motivating factor, they are avoided by many physicians. The result is a situation in which many patients fail to communicate their desires for the end of their lives, they fall in the default pathway of over-utilization of resources at the end-of-life, with invasive and often pointless interventions that have no benefit and burden and overwhelm the health-care system. The ideologues who sank that language in the bill should truly rot in hell, because they destroyed a good thing just to create a bogus political argument.

    And speaking of the death panel conspiracy theory, has anyone been checking out Arthur Goldwag’s coverage of Sarah Palin’s conspiratorial beliefs? How sad is it that we still have candidates for national office that believe things that fail the snopes.com test? Palin gives me the creeps, she represents my worst nightmare, a crank candidate with inroads towards a national campaign. Goldwag’s writing on the birther movement is also excellent and I’m glad to see these crackpots are being laughed out of court for the fools they are. In particular I liked the text of Judge Carter’s decision describing what it’s like to deal with cranks in court:

    The hearings have been interesting to say the least. Plaintiffs’ arguments through Taitz have generally failed to aid the Court. Instead, Plaintiffs’ counsel has favored rhetoric seeking to arouse the emotions and prejudices of her followers rather than the language of a lawyer seeking to present arguments through cogent legal reasoning. While the Court has no desire to chill Plaintiffs’ enthusiastic presentation, Taitz’s argument often hampered the efforts of her co-counsel Gary Kreep (“Kreep”), counsel for Plaintiffs Drake and Robinson, to bring serious issues before the Court. The Court has attempted to give Plaintiffs a voice and a chance to be heard by respecting their choice of counsel and by making every effort to discern the legal arguments of Plaintiffs’ counsel amongst the rhetoric.
    This Court exercised extreme patience when Taitz endangered this case being heard at all by failing to properly file and serve the complaint upon Defendants and held multiple hearings to ensure that the case would not be dismissed on the technicality of failure to effect service. While the original complaint in this matter was filed on January 20, 2009, Defendants were not properly served until August 25, 2009. Taitz successfully served Defendants only after the Court intervened on several occasions and requested that defense counsel make significant accommodations for her to effect service. Taitz also continually refused to comply with court rules and procedure. Taitz even asked this Court to recuse Magistrate Judge Arthur Nakazato on the basis that he required her to comply with the Local Rules. See Order Denying Pls.’ Mot. For Modification of Mag. J. Nakazato’s Aug. 6, 2009, Order; Denying Pls.’ Mot. to Recuse Mag. J. Nakazato; and Granting Ex Parte App. for Order Vacating Voluntary Dismissal (Sep. 8, 2009). Taitz also attempted to dismiss two of her clients against their wishes because she did not want to work with their new counsel. See id. Taitz encouraged her supporters to contact this Court, both via letters and phone calls. It was improper and unethical for her as an attorney to encourage her supporters to attempt to influence this Court’s decision. Despite these attempts to manipulate this Court, the Court has not considered any outside pleas to influence the Court’s decision.
    Additionally, the Court has received several sworn affidavits that Taitz asked potential witnesses that she planned to call before this Court to perjure themselves. This Court is deeply concerned that Taitz may have suborned perjury through witnesses she intended to bring before this Court. While the Court seeks to ensure that all interested parties have had the opportunity to be heard, the Court cannot condone the conduct of Plaintiffs’ counsel in her efforts to influence this Court.

    Plaintiffs have encouraged the Court to ignore these mandates of the Constitution; to
    disregard the limits on its power put in place by the Constitution; and to effectively overthrow a sitting president who was popularly elected by “We the People”-over sixty-nine million of the people. Plaintiffs have attacked the judiciary, including every prior court that has dismissed their claim, as unpatriotic and even treasonous for refusing to grant their requests and for adhering to the terms of the Constitution which set forth its jurisdiction. Respecting the constitutional role and jurisdiction of this Court is not unpatriotic. Quite the contrary, this Courtconsiders commitment to that constitutional role to be the ultimate reflection of patriotism.
    Therefore, for the reasons stated above, Defendants’ Motion to Dismiss is GRANTED.

    You can just taste the crankery. The complete looseness with the truth as long as it conforms to the warped worldview of these crackpots is part and parcel of cranks the world over. Reading the follow-up of this case from right wing sites like Free Republic, and Storm Front, it’s impossible to tell the difference between the conservative ideologues and the unrepentant racists. All the appeals to patriotism and the constitution are such weak cover for the fact these cranks are angry we have a black president.

    I continue to work the long hours of a surgical intern and must say, it’s a lot of drudgery. Internship is much more about paying your dues than about learning a whole lot, although my daily routine is occasionally punctuated by moments of extreme excitement. For instance, I will not forget the first time I placed a chest tube in a patient in the bedside, the blood that poured out of the guys chest that was keeping him from breathing, or the time I walked into a room to discover a patient in the midst of having a heart attack. Luckily, the training sets in, and we have a lot of supervision, so even when things get crazy I’ve always got someone with me who has seen it all before.

    I also am increasingly motivated to write more as I feel less plugged-in than ever to the outside world since writing at least forced me to read tons of diverse information on lots of different topics. Cranks and crankery are all around us and I’m constantly reminded of the problems they create. It seems every time I see some topical show, and the commentators pause to reflect for a moment on the problem they’re all facing, it seems like they all know what the problem is but just don’t have a good name for it. The problem is that lies can be equally effective as the truth, and denialism creates very real problems for us and our democracy every single day. Denialism works, and cranks run amok throughout our country and the world. We have to keep writing about it until rather being on the tip of everyone’s tongue, people are willing to come out and call out denialism for what it is, and shout it down when it rears its ugly head.

  • Get the H1N1 Vaccine Where the Poors Are!

    The Viking and I ventured out early this morning to get the H1N1 vaccine and found long lines in the tony neighborhoods. SF Gate reports that the Marin public vaccination clinic was swamped. (The irony!–Marin is a hotbed of the anti-vaccination movement.) So where can you get the vaccine quickly? Downtown! We were in and out in less than an hour! There’s almost no one there.

  • I Increasingly Am Horrified by My Sex and Apologize Collectively for All Men to All Women


    Exhibit 1001, on our great college and university campuses, this wretch can complain of coyote ugly. The nerve. Nice hat, BTW. Do you have a matching jersey? Ladies, imagine waking up with this puffy misogynist! Via Gawker.

    Exhibit 1002, Southern Football’s Dating Game in Today’s WSJ.