Medical Education and the 'Atypical' Presentation

One and a half years of medical school has at least taught me one thing: medicine is all about getting the right diagnosis.  Sure, there are important things like treatment, but honestly, evidence based treatment guidelines and experiential wisdom can all be looked up.  And as people realize that the way we teach is just as important as what we teach, most clinically savvy professors have done away with the old-school method of disease definitions.  These days they give us the symptoms, we generate a differential diagnosis (the list of likely issues based on the case history), and then we learn the diseases.

And so basically, as medical students we’re taught pattern recognition and probabilities.  Have a person in the hospital that has sudden kidney failure a few days after an aggressive bacterial infection?  That’s the classic pattern for aminoglycoside toxicity.

Or maybe you’re told your patient who has a terrible cough that won’t go away.  She’s worried because she watched a movie with someone who had lung cancer that coughed in similar way.  Without any other information, sure, some sort of lung or throat cancer is on your differential.  Find out she’s never smoked and hasn’t had unexplained weight loss? Suddenly the chances of her having cancer are much lower.  And then it turns out she has high blood pressure and is on an ACE Inhibitor.  The odds are completely different now.  Cancer is way down and side effect of her medication is really high on the list.

Taking a Moral Stand Outside the Obama White House

Washington–Defense Secretary Robert Gates may be the consummate insider bureaucrat and a nice man, but his calling our war in the Pashtun homeland “the meat in the sandwich” begins to get at the real problem of the Afghanistan/Pakistan War.

Besides being a preposterously flippant and insensitive metaphor presumably uttered for the consumption of the more clueless elements of middle America, his sandwich image is as misleading as all the war-selling PR coming out of the Pentagon and the Obama White House.

Robert GatesRobert Gates

Here’s how he described his sandwich: “The Pakistanis come in behind the insurgents from the Pakistani side and, coordinating with us and the Afghans, we’re on the other side.” Of course, he’s referring to what is informally dubbed Pashtunistan, down the middle of which Sir Mortimer Durand drew the Afghanistan/Pakistan border in 1893 to divide and conquer the Pashtun people. The border is a Western illusion. And, of course, the Taliban are largely Pashtun.

What’s misleading is the assumption any part of this war is anything but a US manufactured disaster. WikiLeaks and other revelations have made it clear the Pakistanis are highly reluctant to make military assaults into the Pashtun tribal areas. Last week the Pakistanis even outed the CIA chief running the US drone war there; the man was forced to flee due to threats on his life.

So the Obama administration is increasing its lethal drone attacks and deadly night special operations raids into Pakistan, both of which are highly controversial and contribute to the hatred Pakistanis have for the US.

This increase of US military intervention into Pakistan was announced at a White House press conference last Thursday that focused on the release of a much-anticipated assessment from General David Petraeus on the Afghanistan/Pakistan War.

President Obama spoke about the “significant progress” achieved in “disrupting, dismantling, and defeating al-Qaeda in Afghanistan and Pakistan and preventing its capacity to threaten America and our allies in the future.”

Tortured Logic: It's Clear Where the Secrecy-Obsessed Obama Administration is Headed in Its Pursuit of WikiLeaks

With word that Pvt. Bradley Manning, the soldier suspected of being the source of most of the WikiLeaks documents on the wars in Iraq and Afghanistan and the State Department cables, has been held in intensive solitary confinement at the Marine Base brig in Quantico, VA for five months, under conditions that most of the world considers torture, it seems increasingly clear what the Obama administration’s strategy in going after WikiLeaks and its founder Julian Assange is going to be.

Where Mayor Mike Can Push His Poll

So I’m sitting there ready to chill after a long day at my desk when the phone rings. The young woman at the other end of the line wants to know if I am who her computer says I am. Yeah, that’s me, I say. And she starts asking my opinion of how everything is going in New York state, the governor, the legislature, the city council, various politicians, unions in general, unions in specific, public service unions in even more specificity, the city’s budget problems, and finally New York City Mayor Mike Bloomberg.

Ah, Mayor Mike. A man of the people, and the 23rd richest person in the world. On the one hand, I applaud his efforts to discourage smoking. On the other hand, I promised myself that I would never forgive him for not allowing the hundreds of thousands of protesters who marched by the Republican convention in 2004 to have a rally in Central Park. But he’s refused to be a demagogue about the mosque near the World Trade Center. Can you imagine what that fascist hambone Giuliani would have said about the mosque if he was still mayor? So that’s kinda okay. But he’s a tool of Wall Street and the real estate sleazebags. And he appointed some idiot magazine editor to be head of the public schools…

Sir? Sir?

He’s just another rich guy who thinks a hotshot business executive like himself could solve all our problems if he was president, and he’s getting his name mentioned as a presidential candidate by columnists who figure they might have to write for Bloomberg News some day, because everyone else is going out of business.

Sir? Do you strongly approve, somewhat approve, somewhat disapprove, or strongly disapprove of New York Mayor Mike Bloomberg?

I would say strongly disapprove, with the proviso that he’s not the worst bag of dirt in American politics.
Bloomberg sits on $18 billion, making him one of the world's richest menBloomberg sits on $18 billion, making him one of the world's richest men

News Black-Out in DC: Pay No Attention to Those Veterans Chained to the White House Fence

There was a black-out and a white-out Thursday and Friday as over a hundred US veterans opposed to US wars in Afghanistan and elsewhere around the world, and their civilian supporters, chained and tied themselves to the White House fence during an early snowstorm to say enough is enough.

Washington Police arrested 135 of the protesters, in what is being called the largest mass detention in recent years. Among those arrested were Ray McGovern, a former CIA analyst who used to provide the president’s daily briefings, Daniel Ellsberg, who released the government’s Pentagon Papers during the Nixon administration, and Chris Hedges, former war correspondent for the New York Times.

No major US news media reported on the demonstration or the arrests. It was blacked out of the New York Times, blacked out of the Philadelphia Inquirer, blacked out in the Los Angeles Times, blacked out of the Wall Street Journal, and even blacked out of the capital’s local daily, the Washington Post, which apparently didn’t even think it was a local story worth publishing an article about (they simply ran a photo of Ellsberg with a short caption).

Veterans chain themselves to White House fence to protest Afghan WarVeterans chain themselves to White House fence to protest Afghan War

Making the media cover-up of the protest all the more outrageous was the fact that most news media did report on Friday, the day after the protest, the results of the latest poll of American attitudes towards the Afghanistan War, an ABC/Washington Post Poll which found that 60% of Americans now feel that war has “not been worth it.” That’s a big increase from the 53% who said they opposed the war in July.

First in the Hearts of his Countrymen? Bringing George Washington's Philadelphia Slave History to Light

Philadelphia–When historians started digging into the facts about the first “White House,” where President George Washington lived when Philadelphia was the nation’s capital, they dredged up more than just mundane data.

They also dredged up the seamy saga of the first president’s slave legacy here in the “Cradle of Liberty,” where the hero of America’s Revolution brought nine of his house slaves, only to see them embarrass him by trying desperately to escape from bondage.

At high noon on December 15, 2010, hundreds of people, including Philadelphia’s Mayor Michael Nutter and other dignitaries, brushed off bone-chilling cold to participate in a controversial yet truly historic event – the grand opening the first monument to slavery ever erected on federal property.

That monument is among the elements in the eclectic mix of items comprising a new exhibit at Philadelphia’s storied Independence National Historic Park that honors the mansion where America’s first two presidents – George Washington and John Adams – lived while in office.

Philadelphia served as the capital of the United States from December 1790 until May 1800.
That multi-media exhibit, entitled “The President’s House: Freedom and Slavery in the Making of a New Nation,” is the result of an eight-year battle over how best to both commemorate the nation’s first White House while recognizing the role of slavery inside that house and the nation as a whole.
Washington's Philadelphia slaves memorialized on Independence Mall (photo by Linn Washington)Washington's Philadelphia slaves memorialized on Independence Mall (photo by Linn Washington)

Letter from Denmark: Stop Fascism in the Making: Support Wikileaks!

Julian Assange, key initiator of Wikileaks, has been granted bail despite the British government’s appeal made in behalf of the Swedish government. A British district court judge had waited two days before approving bail in the amount of $ 316,000, on the condition that Assange wear an electronic tag, report to a police station daily, and comply with a 16-hour curfew allowing just eight hours of freedom from the “mansion arrest” in the house of a wealthy journalist/club owner.

At play here could well be documents Wikileaks released that show that US diplomats communicated with their State Department and White House bosses in Washington saying British troops in Afghanistan are not very good at the job. Brits are angry about this slur, especially given their long record of standing “shoulder to shoulder” with Bush’s in his terror wars.

Also, many Swedish politicians are angry after other Wikileaks documents exposing how, unknown to its parliament, Sweden’s military and secret services have long worked behind the scenes with NATO and have offered more assistance to the CIA than is legally permitted in supposedly neutral Sweden.

Assange wasn’t immediately released, as not all the bail money has been raised. It is difficult to get money to the defense, because the US government pressured conveyors of donations and website servers for Wikileaks’ homepage to end cooperation. Paypal, Visa, Mastercharge, Assange’s own Swiss bank, and other Establishment businesses have frozen Assange and wikileaks accounts and refused to process donations.

Democratic Argument for Extending the Bush Tax Cuts Insults our Intelligence

The Democratic argument for approving the rancid “compromise” reached between President Obama and his GOP “hostage-takers,” which would extend the outrageous Bush tax-cuts for another two years and allow individuals to pass on, tax-free to heirs, up to $5 million, $10 million for married couples), is that members of Congress cannot afford to allow taxpayers to see more taken out of their paychecks come Jan. 1, 2011, when the Bush tax cuts currently expire, and cannot allow the long-term unemployed to lose their unemployment compensation extended benefit checks, which are set to expire too on that date.

This assumes that Americans are too stupid to realize that it is the Republicans’ insistence on extending the tax cuts for the obscenely rich that is preventing Congress from simply extending the cuts for the middle class, limiting the inheritance tax exemption, and passing an extension of the unemployment extended benefits program.

How much savvy does that really take though? Polls show that a majority of Americans thinks that the tax cuts should be ended for the wealthy, who after all, have only been getting richer these past few years while the rest of us have gotten poorer, and that wealthy estates should be taxed heavily. Polls also show that a majority of Americans say that unemployment is the biggest problem facing America today.

Pay No Attention To The Man Behind The Curtain

It is the climactic scene. Dorothy and her friends stand before the great Wizard of Oz. Toto wanders off and yanks back a curtain to reveal a man busy manipulating levers. Whistles and smoke bombs go off, and the great Oz thunders: “Pay no attention to that man behind the curtain!”
____________

The federal government, the military and the Library of Congress have all ordered those under their power not to look at the material published on the WikiLeaks website because it is illegal and looking would make them criminals. Meanwhile, Julian Assange, the WikiLeaks founder, is still jailed in Britain because his condom allegedly “malfunctioned” while having sex in Sweden with a woman with shady connections to anti-Castro Cubans and US intelligence.

This raises a very real question: How is the US approach to WikiLeaks any different from the tyrannical Chinese government’s crack down on websites publishing things Chinese leaders fear and want to control?

Despite all the “leader of the free world” propaganda hammered into us since first grade, are we really any different? As my dad liked to say, the Chinese were civilized when our WASP ancestors were living in trees. Is it time we stopped letting ourselves be deluded that we’re “exceptional” in the world?

The US government campaign to close down WikiLeaks uses the same tactics as the campaign by the Chinese to thwart its website enemies. They both rely on the intimidation of funding sources, they both publicly smear leaders of the criminalized website and they both use their nation’s legal system, since, in both China and the United States, the legal system has been designed by the powerful class of people most likely to be embarrassed by the revelations on “subversive” websites.

Here’s a novel idea: To make up for the undeserved Nobel Peace Prize given last year to Barack Obama and in line with the more appropriate Peace Prize given out this year to Chinese dissident Liu Xiaobo, next year maybe the Nobel Committee should give the Peace Prize to Julian Assange. Especially if he’s in prison.

Samuel Huntington and US Decline

I’ve generally disdained historians like Bernard Lewis and Samuel Huntington, since both of them were used ad nauseum to bolster the imperial Bush Doctrine of preemptive military violence.

Turkish cartoonist Mustafa Bilgin's take on The Clash Of CivilizationsTurkish cartoonist Mustafa Bilgin's take on The Clash Of Civilizations

But the other day for 35-cents at a thrift shop I picked up Huntington’s 1996 magnum opus, The Clash of Civilizations and the Remaking of World Order. While it has a testimonial on the back from the devil himself, Henry Kissinger, the book is important and more politically neutral than the list of its right-wing militarist worshippers suggest.

Something is Rotten: The Strange Case of Interpol's Red Alert on Assange, and the US Attack on WikiLeaks

Far be it from mem with a daughter of my own, and a wife, to minimize the issue of rape, but to borrow from the Bard, in the case of the “rape” case being alleged against WikiLeaks founder Julian Assange (technically, Swedish prosecutors say it’s not rape, it’s “sex by surprise”), currently being held in a British jail without bail pending an extradition request from Stockholm: “Something is rotten in Sweden.”

As I wrote earlier in this publication, the alleged sexual crimes that Assange is currently being sought for by a Swedish prosecutor are:

1. Allegedly failing to halt an act of consensual sexual intercourse when his sex partner and host, Anna Ardin, claims she somehow became aware that the condom he was using had “split” and,

2. Having consensual sex with a second woman a few days later without informing her that he had just been with Ardin, and then, a day later, allegedly refusing to return a phone call on his cell phone, when she tried to call him to ask him to take an STD test. (Assange says he had turned off and was not using his phone for fear he was being traced through it, not that refusing to take a call from a woman one recently slept with should be considered criminal. Cold or even cruel, maybe, but not justification for a rape charge!)

In most countries, including the US and UK, these would not pass the test to be considered a crime, much less qualify as a category of “rape,” but Swedish authorities, who in all of this year have only submitted one other request to Interpol for assistance in capturing a sex crimes suspect, asked the international police agency to issue a so-called Red Alert for Assange, who was subsquently asked by police in the UK, where he was staying, to turn himself in or face arrest. (The other Interpol Red Alert sought by Swedish prosecutors this year was for Jan Christer Wallenkurtz, a 58-year-old Swedish national wanted on multiple charges of alleged sex crimes and sex crimes against children.)

The Interpol Red Alert page on Assange. Curiously, the agency couldn't find a photo to accompany the alert.The Interpol Red Alert page on Assange. Curiously, the agency couldn't find a photo to accompany the alert.