Cryptic

"Are -are you there too, Sir?" said Edmund.

"I am," said Aslan. "But there I have another name. You must learn to know me by that name."

-- The Voyage of the Dawn Treader

Something rotten in the state of Pennsylvania

For those of you who have missed the gruesome case of Kermit Gosnell and his victims, Slate has a grim article. It reads like something from an Eli Roth movie. [For the second time in a week, I feel moved to offer a disclaimer that the article details some horrifying crimes. It (and the remainder of this post) should be avoided if you're squeamish.] Gosnell, a Philadelphia doctor (I can barely bring myself to type that word, in this case), is accused of numerous things, the most grievous being the murder of newborns by severing their spinal cords.

The case throws into stark relief some of the more pressing ethical questions about abortion and murder, certainly late-term abortions. I intend to side-step that thorny issue, and to focus merely on the same question William Saletan appears to be asking in his series of articles on the subject -- how could this have been allowed to happen, and how did the politics of abortion contribute?

There are these disturbing images:

The grand jury's report, citing forensic evidence and testimony from clinic employees, accuses Gosnell of routinely delivering viable babies and severing their spinal cords. But it also details ill treatment of women. According to the report, Gosnell used unlicensed workers to administer anesthesia, failed to obtain patients' informed consent, gave them expired drugs; endangered their health with poor sanitation and broken equipment, and caused the deaths of at least two women.

Unless I am gravely mistaken, one of the central tenets of the pro-choice movement is that restrictions on abortion will lead to unsafe conditions just like this, except performed in back alleys. Apparently this clinic exists as some kind of horrible converse.

From 1993 on, Gosnell went completely uninspected. The grand jury says the health department "decided, for political reasons, to stop inspecting abortion clinics at all. … With the change of administration from Governor Casey to Governor Ridge, officials concluded that inspections would be 'putting a barrier up to women' seeking abortions." Casey was pro-life; Ridge was pro-choice.

I cannot understand this at all. In a world where our restaurants are inspected to confirm a basic level of sanitation, how can a "clinic" where invasive medical procedures are performed escape even the barest scrutiny? This seems like the worst effect of the worst kind of political cowardice.

This just sent me over the edge:

The other agency that could have stopped Gosnell was Pennsylvania's Department of State, which included the state Board of Medicine. According to the grand jury, the department ignored complaints about Gosnell for years. The complaints involved unlicensed administration of anesthesia; sexually transmitted infections (apparently spread by the clinic itself); perforated uteruses, cervixes, and bowels; hospitalizations of infected patients; and family members prevented from summoning emergency aid. The consequences allegedly included a hysterectomy and a patient's death.

This truly enrages me. A few years ago, a completely frivolous complaint was filed against me; it was absurd on its face. Despite its obvious lack of merit, I had to go through a lengthy response process, during which time the complaint and the records were reviewed by the Board (in a different state). The complaint was dismissed as soon as it could be, but even for a gripe as patently ridiculous as the one I faced, a very formal protocol was followed.

Seeing how grossly patient welfare can be affected by a break-down in the system meant to protect it, I am almost grateful for the seeming other extreme of my own experience. (I still think there should be a speedier process for dispensing with complaints that are clearly frivolous or abusive.) Given the gravity of the multiple complaints lodged against Gosnell, every single person involved in handling them is guilty of negligence, at the very least.

I understand that the abortion issue is immensely fraught. I can see how onerous regulations could be used to stymie access to legal, safe abortions. But using those issues as an excuse to abdicate regulatory responsibilities is partially to blame for the death of at least two women and many infants. Everyone involved deserves our collective anger, not merely the monster who perpetrated the acts themselves.

Still, it's better than Crash

A few disclaimers:

1) I am not a big fan of hip-hop music. This probably has much to do with the kinds of music I was raised with, which tended toward Nanci Griffith and classical. I do not consider my lack of appreciation a reflection on the inherent quality of the musical form.

2) I am not a big fan of Eminem in particular. I think he is a misogynistic, homophobic lout.

3) I did not watch the Grammy Awards last night. Acting awards shows I watch like a religion. Anything else, music awards shows especially, I skip.

All that said, I know with 100% transcendent certainty that the winner of a couple of last night's big awards was wrong. Deeply, deeply wrong. From the Times:

Asserting the power and versatility of the new Nashville, the country-pop trio Lady Antebellum was the big winner at the 53rd annual Grammy Awards, which were presented on Sunday night at the Staples Center arena here.

In a night of upsets, the band won five prizes, including the top two awards for a single track — record and song of the year — for “Need You Now,” besting Eminem and Jay-Z, as well as sweeping the country categories. It won in every category in which it was nominated except album of the year, which went to the indie-rock heroes Arcade Fire for “The Suburbs,” the first time a band solidly in the alt-rock world has taken that top category.

No. No, no, no.

I have heard "Need You Now" in various shopping centers, occasionally when flipping through channels, and maybe once on the radio before frantically spinning the knob to anything else. "Need You Now" is like Xanax-laced pudding being forced into one's brain through the ears. It makes "We've Only Just Begun" sound like "Darling Nikki." It could make Ambien obsolete.

It is inoffensive enough, I suppose. But there is no way it could possibly be considered the "Best" of anything.

Which cafe is to blame for Pol Pot?

I read a harrowing article in Slate (via Yglesias via Plain Blog) about Stalin and the enforced famine in the Ukraine in the early 1930s. It is, among other things, an exploration of the question about which was "worse," Communism or Fascism, Hitler or Stalin, or whether one can ever meaningfully answer such a question. The article itself hinges on the gruesome facts about cannibalism during the famine, and what it says about the depths to which humanity can plunge itself.

Anyone who clicks through the link should be aware that the article contains very graphic and unsettling descriptions of cannibalism. These details are not central to my point. Ron Rosenbaum, the author, believes it important to state open-eyed at what people are capable of doing to each other in the extremes of suffering and deprivation. I disagree somewhat, in that I think most of us know that unspeakable circumstances produce unspeakable horrors. However, knowing the truth about human history allows us to view the present more honestly, and I think it is important for us not to fool ourselves that human beings are innately incapable of ghastly crimes. (It is also important to remember that the same extremes of suffering and cruelty can also bring out remarkable heroism and charity.)

Having made my way through the article, though, I found myself started by this rather baffling conclusion:

Finally, the only other conclusion one can draw is that "European civilization" is an oxymoron. These horrors, Nazi and Communist, all arose out of European ideas, political and philosophical, being put into practice. Even the Cambodian genocide had its genesis in the cafes of Paris where Pol Pot got his ideas. Hitler got his ideas in the cafes of Vienna.

I don't think that this holds up under even cursory scrutiny.

First of all, it is absurd on its face to say that the killing fields of Cambodia or the horrors of the Great Leap Forward were "European." Their beginnings may have been in the cafes of foreign capitals, out of "European ideas," but they actually occurred far away at the hands of different people. Power-mad, depraved leaders can make the worst of any idea from anywhere, and one civilization is not responsible for the corrosion of another. Pol Pot and Mao did what they did where they did, to and with their own people. You can't blame that one Europe.

Further, even if the most heinous crimes of the 2oth century had their origins in European thought, the Holocaust was a wholesale failure of European civilization, not a negation. European civilization was and is not uniquely resistant to failure (as any passing student of history could tell you), but that doesn't mean that it hasn't existed. The worst that a society can do doesn't cancel out the best. Josef Mengele doesn't void Louis Pasteur, and Joseph Stalin doesn't nullify Immanuel Kant.

Finally, if we're going to blame Europe for the worst foreign iterations of its ideas, then it's only reasonable to credit it for the best. Which means Europe gets credit for American civilization, with its system of laws and civic virtues that herald back to their European roots. Unless one recognizes only the ugly and repellent as true, there is plenty to show that European civilization has inspired beauty and excellent.

Rosenbaum's larger points about the futility of comparing epic evils and trying to determine a system of ranking them stand up much better. When a figure blots out the lives of millions of people, that person defies our ability to categorize and parse, and deserves only the grimmest judgments of history.

If only they'd all boycotted

Oh, bother. I was really hoping that the presence of gays at CPAC would keep social conservatives away en masse. (Good luck infiltrating, guys! We'll squeak our agenda through yet!)

In all seriousness, it would be grand if the GOP would jettison the more obviously theocratic elements of the conservative movement. It would be a small first step toward making them sane again.

Sadly, this guy apparently showed up:

[Grand Hierophant Rick] Santorum also called social issues "the issues that bind us," and that when it comes to those issues, "just because it's not popular doesn't mean it's not true."

"The Judiciary cannot create life, and it did not create marriage, and it has no right to redefine either one," he continued.

"America belongs to God," Santorum said, "and we are the stewards of that great gift."

Who is this "us" that is bound by social issues? I feel a sneaking suspicion that I'm not included in that "us." I rather fear I fall into the "them" category. Further, I suspect that if it gives you pause to think that God owns America, you may also fall into the "them" category.

Between Santorum, Michele Bachmann and Donald Trump (Donald Trump? Really?), I don't think there's been a sane headliner at CPAC yet this year. As much as it chills my spine to think I might agree with Sarah Palin about anything, part of me understands why she never bothers to show up at this thing.

Internet Use 101

Every so often, someone uses a computer in such a flagrantly stupid way that it demonstrates how unfit they are for the job they have, even if the offense itself doesn't seem disqualifying per se. A little while ago it was those SEC officials using their work computers (which also happened to be government computers) to surf the Web for porn. Now it seems that an astounding lack of Internet savvy has cost former Rep. Christopher Lee (R - 1994) his job.

Mr. Lee, if you're reading, here are some tips to guide you as you enter the job market. I wouldn't have thought this was necessary in 2011, but apparently I was wrong.

1) If you're a married member of Congress, you should probably not be using Craigslist to troll for sex.

2) If you disregard tip #1, you should probably not troll for sex on Craigslist by sending out pictures of yourself sans shirt. It makes the fact that you are trolling for sex a wee bit more obvious than is seemly. (Nice guns, though.)

3) If you disregard tips #1 and #2, you should probably crop out your face. Should you find a woman who is interested in hooking up with you despite your rather blatant goals, I imagine you can find a less compromising way to get a picture of your face to her without making you seem quite so indiscreet.

I do feel a little bit sorry for ex-Rep. Lee. I don't really think being a complete nincompoop about Craigslist is disqualifying for elected office, and none of this was really anyone's business. (His wife being the obvious exception.) Perhaps a classier, more admirably live-and-let-live young woman wouldn't have sent the pictures on to Gawker, but that's the risk one runs when disregarding tips #1-3 above, and maybe she thought a married member of Congress had it coming.

Lessons learned too late for quondam MOC Lee. Hopefully his former colleagues are a bit wiser than he.

Unenthused

I am not at all excited about this:

The Huffington Post, which began in 2005 with a meager $1 million investment and has grown into one of the most heavily visited news Web sites in the country, is being acquired by AOL in a deal that creates an unlikely pairing of two online media giants.

The two companies completed the sale Sunday evening and announced the deal just after midnight on Monday. AOL will pay $315 million, $300 million of it in cash and the rest in stock. It will be the company’s largest acquisition since it was separated from Time Warner in 2009.

[snip]

Arianna Huffington, the cable talk show pundit, author and doyenne of the political left, will take control of all of AOL’s editorial content as president and editor in chief of a newly created Huffington Post Media Group. The arrangement will give her oversight not only of AOL’s national, local and financial news operations, but also of the company’s other media enterprises like MapQuest and Moviefone.

I don't think anyone can argue that HuffPo isn't huge. It is an enormously successful site, and there's no question that it's managed to draw lots of eyeballs.

What it isn't is all that good. Its headlines often misrepresent the content of the articles to draw more attention to them. Its health and wellness section is rife with ridiculous pseudoscience and celebrity hooey. In less than twenty seconds I found this article about "doctors" of homeopathy, for whom I have roughly the same degree of collegial respect as your friendly neighborhood witch doctor. This kind of content needs less credibility and exposure, not more.

Further, I'm not sure I understand why Arianna is going to be in charge of content at AOL. HuffPo traffics largely in content generated elsewhere, and then tarted up with an inflammatory, eye-catching headline. True, she has lots of famous friends willing to write pieces of questionable quality for her, but being a well-connected self-promoter isn't necessarily a sign of editorial savvy.

Arianna Huffington is the left's Mitt Romney, pretty much willing to take whichever view is ascendant. While she is ambitious and well-spoken, I am skeptical that she is all that insightful or talented. On the other hand, this can't work out any worse than AOL's Time Warner fiasco.

Hopping off the Hopey-Changey Express

During my evening commute last night, I caught an excerpt of the President's speech at Penn State yesterday on the radio. In the brief bit I heard, he talked about increasing energy efficiency in buildings around the country as a way of helping both the environment and the economy.

The content of what he had to say seemed reasonable enough, and on its face appeared to be part of a sensible economic plan. What left me musing wasn't what little I heard him say, but rather my response to it.

I didn't find him annoying.

Sad to say, the last couple of times I've heard President Obama deliver major addresses, I've come away unimpressed. I'm still very much a supporter, but his much-vaunted oratorical skills have been leaving me cold. Both his speech in Tucson after the Giffords attack and his State of the Union sounded hackneyed and formulaic. Given that most of the reviews I read gave him positive marks, at least regarding the former, clearly it wasn't just that he had given lousy speeches. Why did I find him such a thrilling speaker as a candidate, only to watch the bloom come off the rose when he assumed office?

I think I figured it out. Both his Tucson speech and SOTU were heavy on broad themes. Lots of rhetoric about unity and America's character, lots of grandiloquent language and orotund prosody. In many ways, they were reminiscent of some of his more famous speeches, going back to his heralded (and, in my opinion, brilliant) speech at the 2004 Democratic National Convention.

The problem is that we all know what happened after all those fabulous speeches about changing the culture and tone of Washington, and Hope and Change and such. I remember 2008 fondly, but 2009 came immediately thereafter and blew any illusions about changing DC to smithereens. It was, if anything, even more rankly partisan than before. And while I place the blame for that almost entirely with the GOP, it was a bummer to see that part of my hope for the Obama administration was nothing more than idealistic hooey.

(Yes, yes. I should have known better. Shame on me. But it's not like that was the ONLY reason I voted for him. Hell, with Palin on the other ticket, I would probably have voted for Captain Kangaroo.)

Having now come back to my misanthropic, politically cynical senses, I no longer yearn to hear the POTUS wax poetic about American virtue or character or beauty. Heard it, thanks. Didn't take. Not sure it's his fault, but no longer interested in hearing any more about it. Even if the Tucson event called for such rhetoric, I'm no longer personally receptive to it. (And, sorry, but I still think all the audience whooping was inappropriate.) Any time I hear it now, it sounds hollow and devoid of much merit.

When he gets to specifics, on the other hand, I'm happy to hear him speak.

A question for our media overlords

If I just make crazy shit up, can I be a[n overpaid at any price] pundit, too?

On humility

Yesterday's Times Magazine has a harrowing article about shaken-baby syndrome. Its tragic and shocking subject matter makes it particularly challenging to read. I have (blessedly) never been directly involved in the care of a shaken infant. I remember a case being discussed at morning rounds once during my fellowship in New York City, but my subspecialty is unrelated and I heard nothing further about it. I hope I am lucky enough never to encounter this diagnosis again in the course of my career.

What I know about shaken-baby syndrome (on which I will not dwell in detail) is retained from residency, with a medical education conference or two on the subject since then. There is a constellation of findings that, viewed together, are pathognomonic for the syndrome. That is, if you find these things, they point conclusively toward shaken-baby syndrome. If these, then that, QED.

Except, maybe not?

A dozen years ago, the medical profession held that if the triad of subdural and retinal bleeding and brain swelling was present without a fracture or bruise that would indicate, for example, that a baby had accidently fallen, abuse must have occurred through shaking. In the past decade, that consensus has begun to come undone. In 2008, the Wisconsin Court of Appeals, after reviewing a shaken-baby case, wrote that there is “fierce disagreement” among doctors about the shaken-baby diagnosis, signaling “a shift in mainstream medical opinion.” In the same year, at the urging of the province’s chief forensic pathologist, the Ontario government began a review of 142 shaken-baby cases, because of “the scientific uncertainty that has come to characterize that diagnosis.” In Britain, after one mother’s shaken-baby conviction was overturned, Peter Goldsmith, then attorney general, reviewed 88 more cases. In 2006, he announced doubts about three of the convictions because they were based solely on the triad; in the other cases, Goldsmith said, there was additional evidence pointing to the defendant’s guilt.

I found this genuinely startling. There was such certainty in how I was taught regarding this diagnosis. If this, then that. If retinal hemorrhages and subdural hematomata are present, shaken-baby syndrome is the horrifying but clear diagnosis. Nothing left but to find the perpetrator. While this emerging information doesn't mean a baby with these findings wasn't shaken, it seems this diagnostic certainty is unfounded.

In my current position, I am not on staff in an emergency department. It is supremely unlikely that I will ever be called upon to make this diagnosis. The impact of this new controversy on my particular practice is likely to be minimal.

And yet, this was rather a dizzying article for me to read. It serves as an important reminder that, as a physician, there must always be humility in my approach to individual patients and accepted treatments. As a profession, we must always be willing to admit new information, and to question even the most seemingly unimpeachable evidence. It's good to be reminded of this now and then.

(As an addendum, this might lead regular readers to question if I would be willing to accept a link between vaccines and autism if evidence emerged to suggest it. My reply to this hypothetical question is that I have always been willing to accept a link between the two, were said evidence to meet the standards required of medical science. Given that the supposed link was first introduced through fraud [a fact his supporters are all too happy to blithely ignore] and no compelling science has actually supported a link despite vigorous and good-faith efforts to investigate it, I remain confident in my convictions. Should credible evidence emerge that causes me to question even this belief, I would give it my honest attention.)

Absent from any ledger

I've been meaning to write an additional follow-up post about one thing President Obama mentioned in his State of the Union address, and am only just now getting around to it. As a bone he seemed to throw toward the ascendant GOP, the POTUS mentioned a willingness to consider malpractice reform as the health care reform bill is tossed around during this next Congress.

I, of course, think this is just dandy. I am, after all, a doctor. However, I think it's dandy because I really do believe it will lower health care costs in America.

During my morning commute the next day, they were fact-checking the speech on Morning Edition. Among the things they questioned was how much malpractice costs contribute to health care costs overall. The take-home lesson is that tort reform would save very little money. A similar argument was made a while ago in the Times, and the amount that could be saved was described as a "rounding error" because it would be so small.

I think this misses the mark. Buried in the Times piece is this exchange:

Q.

But it’s not just the cost of premiums and litigation. What about the charge that it causes doctors to practice “defensive medicine,” ordering tests that are expensive and unnecessary?

A.

A 1996 study in Florida found defensive medicine costs could be as high as 5 to 7 percent. But when the same authors went back a few years later, they found that managed care had brought it down to 2.5 to 3.5 percent of the total. No one has a good handle on defensive medicine costs. Liability is supposed to change behavior, so some defensive medicine is good. Undoubtedly some of it may be unnecessary, but we don’t have a good way to separate the two. [italics in original, but emphasis added]

In other words, nobody really knows how much so-called "defensive medicine" (or "CYA medicine" -- you figure it out) really costs. Allow me to suggest that it costs a whole hell of a lot.

I defy you to find a medical provider who has never ordered tests he or she knew to be unnecessary in order to placate an anxious or irate or demanding patient or parent. This is not to say that anxious/irate/demanding health care consumers do not sometimes have real medical problems that are discovered because they pressed for further testing; medical providers are fallible, and sometimes the tests prove to be more important than initially suspected. But there are, I guarantee, innumerable instances when tests or consultations are ordered with low suspected yield, and with little or no useful outcome.

Speaking merely for myself, I try like the dickens to avoid ordering unnecessary tests, and I go to great lengths to explain why I don't think they are indicated. I try to do this in a way that addresses parents'/patients' concerns, so as to avoid making them feel ignored or dismissed. But sometimes the demand persists, and it's a hard call whether it's better to acquiesce or have a pissed-off patient.

Nowhere is there a box to check "I am ordering this to appease a demanding mother" or "This test is to cover a plausible number of obscure diagnoses, thus creating the appearance of due diligence and limiting potential liability." No provider is going to put any indication of this reasoning in the medical record. In fact, just the opposite is likely, with physicians and other practitioners making an effort to explain why they did what they did in case the chart is ever audited by insurance carriers. These costs are, and will remain, hidden.

How much of an impact would tort reform have? I have no idea. But I suspect it is much greater than any study would be able to determine a priori.

Almost makes me wish I ate there

I have never eaten a Chick-fil-A sandwich in my life. I've seen it in various mall food courts (mainly back in the day when I lived in Missouri), and have never been moved to try the food. Something about the weird way they spell the chain's name, with the bizarre phonetics and hyphens and capitalization, gets on my nerves. For an unapologetic nerd like me, that's reason enough to take my chances on the reheated pizza next door.

It seems I've inadvertently been making a sound dining choice. From the Times (with a tip of the hat to my friend Ken):

Nicknamed “Jesus chicken” by jaded secular fans and embraced by Evangelical Christians, Chick-fil-A is among only a handful of large American companies with conservative religion built into its corporate ethos. But recently its ethos has run smack into the gay rights movement. A Pennsylvania outlet’s sponsorship of a February marriage seminar by one of that state’s most outspoken groups against homosexuality lit up gay blogs around the country. Students at some universities have also begun trying to get the chain removed from campuses.

Damn. I can't stop eating at a chain I never tried in the first place.

On a petition posted on the Web site change.org, [Georgia Equality] asks the company to stop supporting groups perceived as anti-gay, including Focus on the Family, an international nonprofit organization that teamed up with Chick-fil-A a few years ago to give away CDs of its Bible-based “Adventures in Odyssey” radio show with every kid’s meal.

Can I just say that a CD of a Focus on the Family radio show may quite possibly be the crappiest kid's meal prize ever? It's like getting a box of dessicated raisins on Halloween.

I think attempts to get the chain booted from college campuses are misguided. While I find the organization's support of fundamentalist Christian, socially-conservative policy odious, it's a free country and the owners of a privately-held company can do whatever they want with their money. I support the rights of people to hold views I consider anathema. The answer to objectionable speech, as my pal Burt would say, isn't to silence it, but to counter it with more speech.

I support the drive to inform people what their money may be subsidizing. People who object can choose to clog their arteries with chicken sandwiches purchased elsewhere. If enough people choose to penalize Chick-fil-A (that is incredibly irritating to type) where it counts, they may choose to stop funding dogmatic bigotry.

---

OK, this is totally off-topic, but since I've already mentioned by nerdish tendencies I'm going to gripe about an unrelated pet peeve in the article.

But Douglas Quint, a concert bassoonist who operates The Big Gay Ice Cream Truck in New York during the summer, said he believed that people should make informed decisions about their food.

“It literally leaves a bad taste because I know the people who are putting this food in my mouth actively loathe me,” he said. “I’m all for freedom of religion, it’s just that I know where I want my money to go and I don’t want my money to go.”

I agree with Mr. Quint about where people spend their money. I love the idea of a concert bassoonist who operates The Big Gay Ice Cream Truck. I only wish he knew what "literally" means. Because unless the actions of Chick-fil-A's owners have altered the flavoring of their sandwiches or the function of Mr. Quinn's taste buds, I believe the word he was looking for was "figuratively."

A less beautiful place

You know, I have no idea how much it costs to have illegal immigrants in this country. I suspect that, being undocumented, it's nearly impossible to get accurate information about how much they contribute to the country by doing hard, unpleasant, low-prestige work for low wages. Maybe they cost more than they contribute, but somehow I doubt it.

No matter the costs, however, I just can't get myself all that riled up about illegal immigrants. Perhaps it's my weak, liberal soul that insists about seeing them as people seeking a better life for themselves instead of menacing parasites. Perhaps it's because fully half of my family arrived in this country after fleeing the Ukraine at the turn of the last century (cue "Anatevka"), and I suspect if you'd polled Americans at the time they wouldn't have been too thrilled at having them here. Perhaps I'd feel differently if I lived in Arizona or another border state with an undeniable problem with drug cartels and crime. Who knows?

However, this just makes me angry (via TPM):

Sen. David Vitter (R-LA) and freshman Sen. Rand Paul (R-KY) have now teamed up -- and they're aiming very high. The two have proposed a constitutional amendment, to get rid of birthright citizenship for the children of illegal immigrants.

From their joint press release, their proposal will declare "a person born in the United States to illegal aliens does not automatically gain citizenship unless at least one parent is a legal citizen, legal immigrant, active member of the Armed Forces or a naturalized legal citizen."

I sought clarification from Vitter's office as to whether this would be a full-fledged amendment to the Constitution, or a lesser legislative route. It is indeed a proposed amendment to the Constitution.

I hope they fail. I hope they fail spectacularly.

One of the things I love most about this country is its embrace of its immigrant past, and its symbolic welcome to oppressed and suffering people from around the world. I thought (wrongly?) that it was a source of national pride. We were ready enough to affix words to that effect in one of our most famous monuments. (Given our more recent disdain for all things French, should we give it back?) It makes America more beautiful, as far as I'm concerned.

Clearly this vision isn't shared by the likes of David Vitter and Rand Paul. Which I don't find surprising. Tragic, but not surprising.

You only get one brain

A few weeks ago, I went onto The Google to look for running resources in my hometown. I enjoy running a lot (except when the Powers that Be insist upon dumping piles of snow on New England every few days *shakes fist angrily at sky*), and was looking into resources for a family member who had indicated an interest in running herself. By searching with "[hometown]" and "running" I found nothing helpful for her, but I did come across a YouTube video of high school running back being interviewed after a game. The description caught my eye, so I watched it. (Sadly, I'm not particularly keen to tell everyone where I'm from, so readers who don't already know my hometown won't be able to find the video in question. Were they so inclined.)

In the video, the player describes taking a hit and blacking out briefly. However, as the interviewer approvingly notes, the player "manned up" and got right back in the game, wherein he apparently made a some impressive plays.

Suffice it to say, my own reaction was less approving. While I am loath to make any diagnosis without my own history and physical, what the player described was almost certainly a concussion. Presuming this diagnosis is valid, he absolutely should not have returned to play, and should have instead received medical attention shortly thereafter. But that wouldn't have been "manning up," I suppose, and would have lacked heroic appeal.

Ben McGrath has an excellent article about football and concussions in the most recent issue of The New Yorker. Anyone who is interested in the subject would do well to read it. It is a subject that deserves as much attention as possible, because the long-term effects of repeated concussions are only just now coming to light. Parents of athletes, particularly in contact sports, should read it with care.

I encounter a lot of patients who have sustained some kind of head trauma during sports participation, and I'm glad to say that coaches and trainers in the area increasingly seem to be treating concussions with appropriate vigilance. I work in a relatively affluent and well-educated area, so it's no surprise that parents here would be more attuned to shifting norms and health care recommendations. While the best approach to concussion management is an area of ongoing research, and there's still a lack of clarity in how best to advise and treat these patients, it is definitely a condition to be respected, and not downplayed or shrugged off.

I don't want to make too much of one video found randomly, even if it is from my hometown. But it certainly reminded me that there are plenty of players and coaches and fans who don't appreciate the long-term significance of concussions (especially more than one) in athletes. We are learning new and encouraging things about brain plasticity, but brain-damaged patients can find themselves progressively and permanently disabled. No sport is worth that.

My long-awaited SOTU reax

Meh.

I'm with Jonathan Bernstein on this one. I thought it was a pretty lackluster speech. I didn't hear anything important or newsworthy. There were still umpteen tedious standing ovations, they just weren't as entertaining because they weren't as obviously partisan due to the seating arrangements. (I was all for the mixed seating in principle, but having sat through the speech and realized once again how full of meaningless theater the SOTU often is, the least I could hope for is entertainment in the future. Switch back.)

I still like President Obama a lot. I think he's shaping up to be a very good president in many ways. There are things I'd like him to address that he hasn't because they're political kryptonite (like entitlement reform), but generally I agree with his policies more than I disagree. I can (almost) guarantee I will vote for him again (given the lack of any GOP candidate I could even conceive of voting for), and I will likely contribute to his campaign.

But man, I just no longer enjoy his speeches. I hear all the rhetorical flourishes and modulations in tone and get annoyed, not inspired. I find him heavy on boilerplate and light on specifics. To quote one of my favorite lines of all time from "The Simpsons," his reference to our "Sputnik moment" smacked of effort. But at least I like him more than this guy.

I consider it something of a duty to watch major presidential addresses, no matter who's in office. It seems like a necessary part of being an informed citizen. But even for a political junkie like me, the State of the Union felt more like a visit to the dentist than even an enjoyable piece of political theater, much less a forum for introduction of anything important. Maybe next year I'll skip it.

Funniest thing I've read all day

This side-splitter from the Dish:

The Dish doesn't hate Palin.

Baaaaaaaaaaaaaaaaaah, hahahahahahahahahahaha!!

*whew*

Look, I think Sarah Palin is the pits. I think she is the embodiment of all that ails American politics these days. If she were to eschew all thoughts of running for high office for perpetuity, I would breathe a sigh of relief and consider the country safer. I make no bones about this, and would be fooling nobody to pretend otherwise.

I am practically the president of the "Up with Palin!" fan club compared to Andrew Sullivan. He haaaaaaaaaaates her. He hates her so much that pretty much everyone who reads his blog has started rolling their eyes whenever he talks about her. It's drawn plenty of commentary and criticism within the political blogosphere, and he occasionally even publishes letters from readers saying "enough already!" His hatred for Palin so clouded his judgment that he embarrassingly embraced the obvious reprobate and famewhore Levi Johnston because Levi possibly had dirt about her. (It didn't hurt that Johnston is good looking.) In fact, this isn't the first time I've said this.

Now, it's his blog and he can bash whom he wants to. But this high-minded sniffing that he doesn't "hate" Palin is galling. It's annoying and fools nobody.

That's it. I'm old -- redux

I remember, in the misty reaches of my youth, a time when Madonna was considered provocative. (Young readers [if you exist], don't snicker. It's true.) Why, watching her writhe around on stage in a bridal gown while singing a song that implied she wasn't a virgin anymore was downright scandalizing!

I was a teenager when MTV decided not to air her "Justify My Love" video, a decision that was considered newsworthy for some reason. I was very into Madonna at the time (what some might consider an example of "foreshadowing"), and was really, really interested in knowing what my favorite pop star had done. My father, being an obliging chap, recorded the episode of "Nightline" during which the video was aired and discussed. I was, as the kids these days would say, totes excited. Imagine my dismay then, when I eagerly pressed "play" on the old VCR, only to find that someone had paused the recorder during the part where the video was shown, and restarted it for the subsequent analysis and discussion. Someone, it turns out, was not so very obliging after all. This was an example of what I understand to be "parenting." (I have since managed to pollute my mind with the video in question.)

I bring all of this up to make two points about the new MTV series "Skins," which they gleefully ripped off from the BBC. I've seen a couple of episodes of the British original, which seems to revolve around the louche lives of a bunch of desultory teenagers. I found it kind of dull, but then again I'm old. Here's what the Times has to say:

Last week, my colleague Brian Stelter reported that on Tuesday, the day after the pilot episode of “Skins” was shown on MTV, executives at the cable channel were frantically meeting to discuss whether the salacious teenage drama starring actors as young as 15 might violate federal child pornography statutes.

Senior executives are now considering additional editing for coming episodes, but that’s a little like trying to lock the door after a naked 17-year-old has already busted out and gone running down the street, which is precisely what one of the characters does in Episode 3 — with a pill-enhanced erection, no less.

Charming.

In retrospect, MTV's refusal to air Madonna's video seems downright quaint, doesn't it? In two short decades they've gone from a firm "no stylized video orgies" stance to possibly violating child pornography laws. Strong work, MTV! Shall we expect hard-core porn in another twenty?

The other thought that crossed my mind reading the Times article this morning was that today's well-intentioned parents are pretty much outta luck if they wish to keep their kids from watching this show. (Lord knows, if I were still an adolescent now, the chances I would be allowed to watch "Skins" are somewhere between "diddly" and "squat.") Media technology being what it is, would-be viewers of any age can find the content with minimal effort on the Internet.

Now, the debate about whether shows like this corrupt otherwise innocent youth or merely reflect the already-corrupt state that they're in is nothing new, and I'm not going to cluck my tongue that society is going to crumble before our eyes because of this particular program. I do think that MTV has done more than any other single media outlet to make our popular culture more obnoxious, idiotic and crass, and yes, I am including Fox in that statement. However, I suspect the Republic will survive yet another assault on its crumbling sense of taste and decorum.

What are modern parents to do? Here's my plan for when the Critter wants to watch whatever horror MTV or the like has made popular when he's a teenager -- I plan to suffer through watching the damn thing myself, and then make him talk to me about it. (If I can suffer through "V," I can suffer through anything.) Trying fruitlessly to prevent him from watching what will then probably be streamable right into his visual cortex seems a waste of effort. Watching it myself and making him listen to my opinion will serve two purposes -- I will be able to at least temper the malign influence of the show with my own perspectives, and I will be able to suck all the pleasure out of his watching it by making it a chore. Nothing is less cool than something your parents make you talk about.

If I can ruin something tantalizing and prurient for my own adolescent son, I will consider myself a success as a parent.

That's it. I'm old

I once caught about half of the tail end of an episode of "Jersey Shore." Knowing it to be a cultural phenomenon, I elected to keep watching once I figured out what I'd found.

I do not understand the appeal of this show on any level. It is poorly-made and edited, with awful production values. It features characters who are not merely boorish and stupid, but are boring to boot. Nothing even remotely fascinating happened, and the only thing I learned is that apparently "smoosh" is the euphemism for fornication favored by a certain subpopulation.

The world does not make sense to me. From the Times:

MTV’s “Jersey Shore” set yet another viewing record Thursday night and once again crushed every competitor in television in terms of reaching younger viewers.

The latest episode of the hit reality show attracted 8.9 million viewers, a new record for any series ever on MTV, up 300,000 from the record the show set a week before.

More viewers watched “Jersey Shore” from 10 to 11 p.m. on Thursday than watched programs on both NBC and ABC. Only the CBS drama “The Mentalist” had more total viewers, with 14.8 million. But “Jersey Shore” had almost double the number of viewers in the advertiser-preferred group of 18 to 49 — 6.2 million viewers to 3.7 million for “The Mentalist.”

The only explanation I can concoct is that some process within my brain has occurred, on some kind of time-released basis. I must have passed a threshold at which point my neurons or endocrine system or something must have stopped synthesizing whatever compound is necessary to enjoy entertainments of this kind. Where I see a collection of louts whose stupidity and crassness are exceeded only by their banality, those lucky people with this mystery hormone or neurotransmitter still in their systems must see a troupe of lovable rascals, whose jolly exploits never fail to captivate and amuse.

Well, nothing to be done about it, I suppose. If you'll excuse me, I'm going to go boil myself an egg, leaf through a nice back issue of Reader's Digest, and lie down for a while.

Hahahahaha... oh, wait.

I just drove over an hour in really awful snow with some of the worst drivers in the developed world (take a bow, New England!), so I was in the mood for something simple and soothing after sitting down to start my day. With coffee in hand, what could be better than making fun of Michele Bachmann? Just what my jangled nerves needed!

Via TPM:

"This is not symbolic, this is why we were sent here and we will not stop until we repeal a president and put a president in the position of the White House who will repeal this bill, until we repeal the current Senate, put in a Senate that will listen to the American people and repeal this bill," Bachmann said on the House floor Wednesday afternoon.

Ha!! "Repeal" the President and the current Senate! What a nincompoop!

Except, before I posted another lazy "I do not think it means what you think it means" snipe, I wanted to be sure she was actually wrong. Sad to say, friends, technically she wasn't.

From Mirriam-Webster:

1: to rescind or annul by authoritative act; especially : to revoke or abrogate by legislative enactment

2: abandon, renounce

3 obsolete :to summon to return : recall

Damn! Curse you, Bachmann! Spoil my fun with your awkward, obsolete but technically (and probably inadvertently) correct usage! You win this round!

Now, if only we could teach her the correct definition of "socialism."

Want to read an interesting take on class in America?

Try this.