mahiwaga

Odd, the synchronicity of this post from someone who is going to be a father. (P.S., the asking of highly detailed, extremely specific questions is not a sign that someone is going to be a good father. In fact, it is extremely annoying to the average health care provider, whether midwife, nurse, or physician, and for some reason, the information they have never seems to comport with either the reasonable guidelines suggested by the American Academy of Pediatrics, or the reasonable guidelines afforded by what is traditionally called “common sense.” One could even go as far to say that such nit-picking and attention to often irrelevant detail is a sign that things may go very badly, and that this individual may very well stifle all things that are good about being a child. The specific details of feeding regimens—except in regards to what will allow your baby not to choke to death from aspirating milk—are pretty pointless, since the correct answer to the question of “When should I feed my baby?” is “When he/she is hungry” and believe me, they’ll tell you when they’re hungry, and the correct answer to “What should I feed my baby?” is “Milk” for the first six months of life. There is a raging debate as to whether you should use breast milk or formula, and the data has a lot of good things to say about breast milk, but if, for whatever reason, this is not going to be an option, I would not let your baby starve to death because someone tells you that formula is evil. Bottom line: you’re doing fine, in my opinion.¹

Since I’m not in a relationship, much less married and about to have a kid, you might think this is an odd thing for me to wonder about. But I did spend the past 26 hours in the special care nursery, and I rounded on all the newborns both yesterday morning and today.

You would think that seeing nine well newborns on the mother-baby unit would take far less time than seeing nine sick newborns in the special care nursery, but I forgot to take into account that parents don’t always feel like they know what they’re doing. (Which brings up an interesting question that a talkshow morning host brought up the other day: why do we need marriage licenses but don’t require baby licenses, considering how much more knowledge is required to succeed at raising a child than in maintaining a marriage? At least, that’s what I think.) For some reason, it takes far more time to discuss feeding than it does to discuss the possibility of pneumonia, or bacteremia, and the need for treatment with empiric antibiotics until blood cultures are back.

I never thought I would be 30 years old and somewhat knowledgeable about child-rearing techniques. Not from actual practice (although I do remember being a kid, so I often fall back on that to try and predict what the average 6 or 7 year old is thinking) but simply because of clinical training.

I am also hanging out with emergency medicine physicians lately, since I’m doing a Toxicology rotation. I wish there was some kind of route into this field without having to do emergency medicine. I guess I’ve always had a strange fascination with poisons, particular those that have CNS effects. Toxicology has all the excitement of saving someone from certain death, without all the messiness involved with cracking someone’s chest open, or flaying their belly open, and it has all the intellectual stimulation of figuring out strange and complex syndromes to boot.

But I digress.

The point being, most EM physicians are horrified at the thought of doing nothing. That is one of the things that drive me insane about the typical emergency department: they admit all these patients to you who have all sorts of things done to them that don’t really help them, but now require a higher level of care. I’m not saying that they necessarily cause iatrogenic problems (although that happens too.) But emergency medicine training simply does not seem to teach people that sometimes the better part of valor is to step back and watch and wait. (The typical rebuttal is, “I would’ve gone into internal medicine if all I wanted to do was watch and wait. Touché.)

But, to me, the idea of doing nothing seems awesome. This is really one of the things that I dig about pediatric primary care. Most kids come in and they’re not really sick, or at least not “sick” sick. (Yes, that’s a technical term.) When they’re not “sick” sick, you can just reassure the parents, tell them to give the kid lots of fluids and Tylenol or Motrin if they need to, and that you expect things to get better in less than a week. And if they get all uppity and crazy and demand to see a specialist, you can pretty easily stall for time by ordering some bullshit “routine” blood tests to placate them (although it sucks for the kid.) By the time you get around to reading the results and calling them back, the kid is usually better. (Never mind that you tortured some kid with venipuncture, that the test results don’t mean jack-shit, and you’ve just wasted some health care resources. At least the parents can’t accuse you of doing “nothing”.)

(I will never get sick of quoting this Fatman clinical pearl: the optimal delivery of health care is to do as much nothing as possible.)

But back to neonates. Especially with the first-time mothers, it’s kind of weird for me, a guy who has no kids, to be teaching a mother with a kid (albeit a kid who is only a few hours old) how to (1) try to feed them (2) how to burp them (3) what to do with fevers (4) how what they’re doing is not really vomiting (5) that the black, tarry stuff in their diaper is normal (6) that the fact that they’re totally tinged orange-yellow is normal. (Sure, at least for half of the stuff, the lactation specialist tends to do a better job, but I can manage in a pinch, usually.)

But I suppose, to take a GI Joe quote out of context, knowing is only half the battle.

The question is: am I ready for fatherhood? Highly doubtful.

Lately I’ve been having this recurring dream of having two daughters (which if you think about it, is kind of nightmarish, although, luckily, they’re not teenagers yet in my dreams.) The elder is named Mireya Angelica, the younger is named Amanda Desiree. (Where does my brain come up with these names? Yikes!) In my dream, I remember being called “Daddy” and that made me burst into tears.

Will it ever happen? Again, the magic 8-ball in my mind says “highly doubtful,” but even extremely low, infinitesimal probability is not the same as no probability, so it may in fact be interesting to find out what happens in the next 10 years or so after all.

See. Watch and wait. I knew I went into the right field.

Technorati Tags: dream, medicine, pediatrics

In an [article in the Chicago Sun-Times][1], Steven Pinker brings up some ideas that are often met with knee-jerk reactions. (The terms “sexist,” “racist,” and “fascist” seem to pop up in the brain for some reason.)

But, in reality, the questions seem to be more of a political litmus test.

This is the stuff that we should be asking our presidential candidates, frankly.

Do women, on average, have a different profile of aptitudes and emotions than men?

As a man, it is tempting to say “yes.” But I’m wary of ascribing a difference to gender, when the variation between individuals irrespective to gender are probably just as variable. I don’t have any data, unfortunately.

Were the events in the Bible fictitious—not just the miracles, but those involving kings and empires?

Having been born and raised Catholic, I was inculcated with the idea that the Scriptures are ideally to be figuratively interpreted and are not the literal truth. So this one is easy for me. There are certain events that have been corroborated by independent pieces of archaelogical evidence. Others could certainly be fictitious.

Do most victims of sexual abuse suffer no lifelong damage?

I suppose it all depends on your definition of abuse, and your definition of damage. It’s been pretty well demonstrated that extreme events (for example, being raped at knifepoint or gunpoint) will cause neuropsychiatric changes that are completely equivalent to that suffered by soldiers who have experienced extremely traumatic events in the heat of battle. Post-traumatic stress disorder is a well described medical condition that we treat to the tune of several billion dollars a year. Not that that’s evidence that it’s real, but the molecular physiologic mechanisms described seem pretty consistent with what we know of neuroscience.

Did Native Americans engage in genocide and despoil the landscape?

Probably. Even modern-day Mayans will postulate the idea that the probable reason for the abandonment of their great cities some millenia ago was probably the result of an environmental catastrophe.

Do men have an innate tendency to rape?

Probably. Rape is rampant in the animal kingdom, and humans are simply animals with the ability to self-reflect. Still, we also have the innate tendency to kill people we don’t like. In other words, it looks like civilization is at least partly based on abandoning instinctual drives.

Did the crime rate go down in the 1990s because two decades earlier poor women aborted children who would have been prone to violence?

This one seems pretty simple, too. The crime rate went down because thanks to Bill Clinton, the nation underwent the largest economic expansion in all of American History. You could probably get stock indices and crime rates to correlate pretty well.

A more radical interpretation could be: the high availability of psychotropic illicit substances 20 years ago may have affected the brains of the resultant children such that their drive to violence was suppressed. How about that one?

Are suicide terrorists well-educated, mentally healthy and morally driven?

Uh. No. Granted, my opinion is pretty tainted. The standard of care in medicine is to assume suicidal ideation is a sign of mental illness. All the cases of suicidal ideation I’ve seen seem to comport with this, although I recognize that anecdotes are not rigorous case studies.

Would the incidence of rape go down if prostitution were legalized?

Doubtful. It’s not like convicted rapists never go see prostitutes.

Do African-American men have higher levels of testosterone, on average, than white men?

This would actually be pretty easy to do a study on. My bets are on the likely conclusion that, much like the conclusions from the studies of DNA similarity, there will be more variation between individuals in their respective cohorts than there will be a statistically significant average difference between cohorts. Anyone want to fund this study? I’ll start enrolling subjects as soon as you send a check.

Is morality just a product of the evolution of our brains, with no inherent reality?

I have no doubt that morality is a construct in our brains that gives us a reproductive advantage with regards to playing game theory. Richard Dawkins in The Selfish Gene makes a good case that altruism maximizes our chances in passing on our genetic material. Hence, morality. As to inherent reality, what is real? I think that morality is no more and no less real than the record of photons that hit your retina which get interpreted by your visual cortex into a coherent model of your surroundings.

Would society be better off if heroin and cocaine were legalized?

Yes. Think of all the taxable commerce! I bet you our tax burdens could be significantly reduced. Think of all the crime that could be obviated because people would no longer have to steal, since the price of these drugs could be driven down to the point where cough medicine would cost more. Think how we could completely ruin drug cartels and terrorist groups by out-competing their production capacities. Think of all the health care dollars we could save by providing drug users with safe, standardized product, not to mention the decrease in disease transmission by allowing them to get their needles.

Is homosexuality the symptom of an infectious disease?

I think that homosexuality has an evolutionary basis, as some kind of trait that allows the maximal transmission of certain genetic material. I think that when we go to the level of molecular genetics, it gets hard to separate what is disease and what is normal genetic transmission. Viruses and bacteria all have pieces of DNA just like the nuclei in our cells, and we are starting to discover that particular traits are actually modified and transmitted by things like transposons, which hitchhike in viral and bacterial DNA.

Would it be consistent with our moral principles to give parents the option of euthanizing newborns with birth defects that would consign them to a life of pain and disability?

I’ll let you on a little secret. We do this already. We just don’t call it euthanasia. There is, after all, a difference between actively ending someone’s life, and simply withdrawing care and letting nature take its course, and for the most part, nature is not merciful.

Do parents have any effect on the character or intelligence of their children?

Yes. This is simple information theory applied to neuroscience. You are what your brain senses. Without stimuli, neurons die. Use it or lose it. How do most children get their stimuli? The people around them. Who is usually around them?

Have religions killed a greater proportion of people than Nazism?

Yes. All I have to do is quote Arnaud-Amaury: Caedite eos! Novit enim Dominus qui sunt eius, which can be paraphrased as “Kill them all and let God sort it out.”

Would damage from terrorism be reduced if the police could torture suspects in special circumstances?

If we have no qualms about torturing suspects (and if Abu Ghraib and Guantanamo Bay is any guide, we clearly do not), we could easily do a randomized controlled trial and see which group stops real terrorist plots: the experimental torture group, or the control lawful interrogation group. I’m talking about real terrorist plots, not the bullshit stuff that the FBI and the CIA make up to keep us scared. I bet $50 that you wouldn’t find a statistically significant difference.

Would Africa have a better chance of rising out of poverty if it hosted more polluting industries or accepted Europe’s nuclear waste?

No, because the poverty is really caused by economic inequality and not just lack of resources. All this would do is funnel even more money to the economic elites in existence. Since Reagan and W have well proven that trickle-down economics doesn’t do shit, particularly when you compare it to the results of FDR’s Keynesian experiment of the New Deal (and the increased federal spending due to World War II), I think it’s a good prediction that poor people will nonetheless remain poor people.

Is the average intelligence of Western nations declining because duller people are having more children than smarter people?

I would argue that this has been happening since sexual reproduction started. We know that increasing intelligence correlates with decreasing sexual activity, throughout all sexually reproducing organisms. It’s that, sometimes, you need to be smart to survive. So there will always be a range where you are too dumb to reproduce, and where you are too smart to reproduce. The range of success is probably pretty broad, though. I’m not convinced that we are generating stupider people, anyway. I just think that our intelligence is not being utilized efficiently.

Would unwanted children be better off if there were a market in adoption rights, with babies going to the highest bidder?

Doubtful. We do this already to a degree. Think of all those Chinese babies that the celebrities adopt. This could also be studied with a randomized controlled trial. I’ll be awaiting your check in the mail.

Would lives be saved if we instituted a free market in organs for transplantation?

No. It’s tough enough to procure organs as it is. Adding a free market component to it would just add another layer of complexity to the process. Imagine the chaos that would ensue if there were multiple organ donation services instead of a centralized system like UNOS. Imagine the geometric increase of the number of phone calls you’d have to make to procure an organ. Imagine how many more people a transplant center would have to hire to make the phone calls. Imagine the delays because of awaiting wire transfers, and making sure the parties involved got their money before starting the harvesting procedure. Think about all the health care dollars being pissed away as you keep a brain-dead person on life support while awaiting the completion of these transactions. Never mind the fact that even on life support, you still only have a limited window of time while the organs are viable.

Should people have the right to clone themselves, or enhance the genetic traits of their children?

Why would you clone? For backup organs? That would be pretty atrocious. Otherwise, big deal. Genetic copies of you with shortened life spans. Yay. I’ve always wanted a twin. As if twins weren’t individuals with human rights. As for genetic enhancement? It’s already happening. It’s going to continue to get more sophisticated whether we like it or not. Still, there is no on-and-off switch for super strength, or the ability to hit home runs, or run four minute miles. So go ahead and let your kids be guinea pigs. I’m sure they’ll really appreciate it.

In an open society, we should be allowed to voice our opinions. But it’s a quid-pro-quo. Your bullshit is no more important than mine, really. It seems like all ATM advocates think that they have some special right to inflict their brand of madness on as many people as possible. Fuck that. There are already well established modes of transmission and propagation for these ideas: politics, the scientific process, the free market. Why should we privilege your crackpot theory by allowing you to bypass these mechanisms that have served humanity pretty well for a few millenia?

Technorati Tags: [atm][2], [medicine][3], [neuroscience][4], [statistics-and-lies][5]

[1]: http://web.archive.org/web/20080509160458/http://pinker.wjh.harvard.edu/articles/media/dangerous_ideas.pdf “In defense of dangerous ideas • In every age, taboo questions raise our blood pressure and threaten moral panic. But we cannot be afraid to answer them. • 2007 Jul 15 • Steven Pinker • archived 2008 May 9 • Wayback Machine • link revised 2015 Nov 17” [2]: http://www.technorati.com/tag/atm “atm • Technorati • link dead • last checked 2016 Feb 23” [3]: http://www.technorati.com/tag/medicine “medicine • Technorati • link dead • last checked 2016 Feb 23” [4]: http://www.technorati.com/tag/neuroscience “neuroscience • Technorati • link dead • last checked 2016 Feb 23” [5]: http://www.technorati.com/tag/statistics-and-lies “statistics and lies • Technorati • link dead • last checked 2016 Feb 23”

Your results:
You are Apocalypse

Apocalypse		65%	You believe in survival of the fittest and you believe that you are the fittest.
Mr. Freeze		64%
Magneto		63%
Green Goblin		59%
The Joker		58%
Dr. Doom		56%
Poison Ivy		52%
Venom		51%
Dark Phoenix		50%
Two-Face		43%
Juggernaut		39%
Lex Luthor		38%
Kingpin		32%
Catwoman		31%
Mystique		31%
Riddler		22%

</tr> </tbody> </table>

Click here to take the Supervillain Personality Quiz

I’ve been trying to cross-post some of my blog posts on MySpace. Why do I bother, you may ask? Frankly, it’s probably because, deep down inside, I’m a narcissist and an exhibitionist, and I want to expose myself to as large a population as possible, and fact of the matter is, everyone and their mom seems to be on MySpace.

But Rupert Murdoch and his minion Tom don’t make it easy. First off, there is absolutely no API for posting to a MySpace blog. There have been previous attempts at creating a MySpace blogging client, but News Corp purposefully breaks them by intermittently changing (and obfuscating) their design. Part of the rationale is that this helps stem the tide of spam. (Damn those fembots.) But it feels very Orwellian. After all, all they really would have to do to prevent spammers from taking over the blog space completely is simply to rate-limit posting. After all, no legitimate blogger needs to post something every 2 seconds.

Secondly, the generated code is extraordinarily atrocious. It looks like a bunch of monkeys coded the site. Or maybe a drunken AI. Your blog entries are embedded in a set of nested tables. Barf. I hope none of the folks who work on this crap consider themselves web designers. Because if this crap is in your portfolio, I guarantee no one in their right mind will hire you. (You should count your blessings that there are plenty of insane people out there with money to spend.)

Seriously, though. I spent about half an hour trying to make my MySpace blog slightly less vomiting-inducing. Looking at the HTML source code made me feel very dirty at the end. MySpace developers seem to have a religious fervor towards breaking every sane convention for coding in HTML . (Seriously. Look at how they tag the subject line of the blog entry so that it ends up including the categories and your mood indicator. Barf. Barf x 2. WTF?!?!) Use of the <br> element abounds. Blank spacer GIFs are everywhere.

What I find remarkable is that you can actually use CSS to fix some of these atrocities. To a degree. (What you really need is an XSL transformer. Or a brainwashing machine like in “A Clockwork Orange” so that these bastards MySpace developers will learn how to avoid coding like idiots.) I feel very accomplished after inserting all sorts of kludgery so that my mirrored blog posts look semi-sane.

It’s little things like this that make me believe that Facebook is going to make MySpace completely irrelevant. One of these days, there will be more fake people on MySpace than real.

Facebook makes it trivial to mirror your blog onto your profile. All you have to do is use the “Notes” FB app to import your RSS or Atom feed. Facebook also respects the adage that “It’s all about the content!” While you don’t have any freedom to change the look-and-feel of Facebook the way you can screw around with MySpace, this also prevents you from creating absolutely disgusting profile pages, with music that you can’t stop from playing. (Seriously, the average MySpace profile looks like a personal website from around 1997. I’m amazed that no one used the <blink> tag.) In the meantime, due to Facebook’s app framework, you can put almost any sort of content on your profile page. In contrast, on MySpace, the best you can really do is embed Flash. This tends to make scrolling though the average MySpace profile absolute torture, even on relatively up-to-date machines.

I really don’t understand it, though. I mean, Rupert Murdoch and News Corp have gigatons of cash. I don’t understand why they can’t manage to hire semi-competent programmers.