Saturday, March 21, 2009

CRPS/RSD Clinical Trials

Clinical Trials listed as recruiting/not yet recruiting as of 21 March 2009 at
1 Autonomic Dysfunction and Spinal Cord Stimulation in Complex Regional Pain Syndrome Condition: Complex Regional Pain Syndrome
Interventions: Device: Spinal Cord Stimulator; Other: CRPS patients under treatment other than spinal cord stimulator

2 Effect of Delta-9-Tetrahydrocannabinol on the Prevention of Chronic Pain in Patients With Acute CRPS (ETIC-Study) Conditions: Complex Regional Pain Syndromes; CRPS
Intervention: Drug: Delta9-Tetrahydrocannabinol

3 Safety and Efficacy Study of Ethosuximide for the Treatment of Complex Regional Pain Syndrome (CRPS). Condition: Complex Regional Pain Syndrome
Interventions: Drug: Placebo; Drug: Ethosuximide

4 (Not yet recruiting) Graded Exposure (GEXP) in Vivo Versus Physiotherapy in Complex Regional Pain Syndrome Type I (CRPS-I) Condition: Complex Regional Pain Syndrome Type I
Interventions: Behavioral: Graded exposure in vivo; Behavioral: Physiotherapy

5 Double Blind Placebo Controlled Study of Outpatient Intravenous Ketamine for the Treatment of CRPS Condition: Complex Regional Pain Syndrome
Interventions: Drug: Ketamine; Other: IV NSS; Other: Normal Saline

6 Not yet recruiting Pain Exposure Physical Therapy (PEPT) Versus CBO in Patients With Complex Regional Pain Syndrome Type I (CRPS-1) Condition: Complex Regional Pain Syndrome, Type I
Interventions: Procedure: PEPT; Procedure: CBO standard

7 Association Between Focal Dystonia and Complex Regional Pain Syndrome Conditions: Focal Dystonia; Peripheral Nervous System Disease

8 Not yet recruiting The Effect of Transcranial Direct Current Stimulation (t-DCS) On the P300 Component of Event-Related Potentials in Patients With Chronic Neuropathic Pain Due To CRPS or Diabetic Neuropathy Conditions: Diabetic Neuropathies; Complex Regional Pain Syndrome Type II
Intervention: Device: TDCS/sham procedure on five consecutive days

9 A Study of the Effect of Lenalidamide on Complex Regional Pain Syndrome Type 1 Condition: Complex Regional Pain Syndrome, Type 1
Intervention: Drug: Lenalidamide

10 Evoked Fields After Median and Ulnar Stimulation Condition: Complex Regional Pain Syndromes
Intervention: Procedure: Evoked fields before and after a local block (Xylocaine)

11 The Efficacy of Motor Cortex Stimulation for Pain Control Conditions: Neuropathic Pain; Phantom Limb Pain; Stump Pain; Brachial Plexus Avulsion; Deafferentation Pain; Facial Pain; Complex Regional Pain Syndrome
Intervention: Device: motor cortex stimulation

12 Neurotropin to Treat Chronic Neuropathic Pain Conditions: Causalgia; Reflex Sympathetic Dystrophy
Intervention: Drug: Neurotropin

13 Evaluation and Diagnosis of People With Pain and Fatigue Syndromes Conditions: Fatigue; Fibromyalgia; Pain; Complex Regional Pain Syndrome; Reflex Sympathetic Dystrophy

14 Regional Anesthesia Military Battlefield Pain Outcomes Study Conditions: Anxiety Disorders; Complex Regional Pain Syndrome Type II; Depressive Disorders; Post-Traumatic Stress Disorder; Substance Abuse
Intervention: Procedure: Regional Anesthesia

15 Susceptibility to Chronic Post-Traumatic Extremity Pain Condition: Chronic Pain

Sweet 16

Texas is going down...

Funny how the cameras always seem to catch Coach K in prayer just prior to tip-off. Harumph.

Prayer? We don't need no stinkin' prayers!

** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ ** ^^ **
okay, so the score is tied with about a minute and a half on the clock. obviously, coach k didn't pray his best prayer.

oh, b-ball god in heaven, let them sink a three pointer and draw a foul. 'kay? je vous remercie de tout mon coeur...

47 seconds and duke hits 2 freethrows, up by 2 now. down the court... and texas misses (by the grace of the b'ball god in heaven) nice rebound by the devils. another foul series for dddduuukkkkeeee and we're up by 3 (henderson misses his last foul shot, but that's okay...). 11.5 seconds. people are fouling out -- like flies (like flies? whatever.)

7.2 now and the blue devils are up by 4 -- now... it *could* be done... yeah, right, if you were a member of the cardiac pack! those were the days, eh?

whew. lesson? join the coach in prayer; do not mock the basketball deities. watch out villanova!

Urban Dictionary


A preminition that is in the past.

I had a repreminition that sue did cheerleading in a short skirt.

by michael dinapoli Sep 5, 2007
The Pilsnick

Something that is really cool and/or popular

Yo, that booty is the pilsnick! Look at that shit jiggle!

by Joemc37 Jul 17, 2008

to describe how berry college really is

hows life at berry? berrysuckage or... berrysuckagely

by hallie Jul 9, 2003

1. the first time u have sex

i got liad and it really hurt.

by anonymous Jul 3, 2003


Pregrant can be two things: The scent of pregnancy or

When a pregnant woman is moody and goes on a rant about anything.

"My wife is so moody! I'm getting tired of all the pregrants." or

Person A: "Do you like my new perfume?"
Person B: "You smell like pregnancy."
Person A: "Yeah that's why it's called Pregrant."

by Nicki Renee Dec 23, 2008


Two or more words that are spelt out using the same series of keys in a text message

Guy is a textagram of Ivy. Anna is a textagram of Bomb.

by Guy Jeremiah March 14, 2009

Round Two

It's noon, Saturday, March 21, 2009. "So what, Retired Educator?" you are probably asking, all mumbly.

Well, messieurs et mesdames... Oops! Women (and children) first: lifeboats, turns, in queues, down the slide of a wrecked plane. (Not to be confused with a woman's prerogative to change her mind.)

Well, mesdames et messieurs -- The Second Round of the NCAA Men's Basketball Tournament is on, today and tomorrow.

I did my best to make some outrageous picks, but ended up following the seeding, with four exceptions, those being:

UCLA (6) over Villanova (3)
Arizona State (6) over Syracuse (3)
Cleveland State (13) over Arizona (12)
Maryland (10) over Memphis (2)

Yes, it does appear contrived, doesn't it? Funny how it works out to be one quasi-upset per region -- though I really do mean it when I pick Maryland, my most daring choice.

The Sweet 16 in the Midwest: Gotta be Louisville and Cleveland State (okay, okay, there's a decent chance that they'll face Arizona) -- either way, Louisville is in the Elite 8.

I see Kansas and Michigan State, with a small upset in the offing, as Kansas squeeks by to face off with Louisville.

As for the West, I have a soft spot for UConn and they'll win easily over Purdue or Washington. Frankly, the only team that interests me in the bottom of that bracket is Maryland. I just would like for them to pull off some upsets. Because they represent the ACC and because they TOPPLED that POWERHOUSE (and my alma mater) Cal. (Note that there is no sarcasm available to drip on Cal's 3-pointer capabilities.) Anyway, I am betting Maryland and Missouri in the Sweet 16.

In the East, UCLA and Villanova? It hardly matters, as the winner faces Duke, who will kick major booty, either way. I picked UCLA but was really very, very impressed watching Villanova over American in the first round. I am talking about how they finally turned it on to come out of a 14-point hole to blow American away. It's important to note those teams that fight off threats and correct course. And, hell, it makes it so much more interesting...

All of which will set up Pittsburgh and Duke, apologies to Wisconsin/Xavier -- which will give me a coronary.

I gotta throw my Cameron Crazies tee shirt in the wash. Tip-off time for Texas v. Dukedom is 8:15.

In the South? It'll be UNC and Gonzaga in the Sweet 16 -- and that ought to be one hell of a game. I am pulling for UNC, but won't be surprised if Gonzaga pulls off an upset.

I picked Arizona State (v. Syracuse) who will face Oklahoma, unless Michigan shocks the world.

Pablo Neruda, "No te amo... "

Soneto XVII (No te amo... )

No te amo como si fueras rosa de sal, topacio
o flecha de claveles que propagan el fuego:
te amo como se aman ciertas cosas oscuras,
secretamente, entre la sombra y el alma.

Te amo como la planta que no florece y lleva
dentro de sí, escondida, la luz de aquellas flores,
y gracias a tu amor vive oscuro en mi cuerpo
el apretado aroma que ascendió de la tierra.

Te amo sin saber cómo, ni cuándo, ni de dónde,
te amo directamente sin problemas ni orgullo:
así te amo porque no sé amar de otra manera,

sino así de este modo en que no soy ni eres,
tan cerca que tu mano sobre mi pecho es mía,
tan cerca que se cierran tus ojos con mi sueño.

-- Pablo Neruda, 1960

XVII (I do not love you...)

I do not love you as if you were salt-rose, or topaz,
or the arrow of carnations the fire shoots off.
I love you as certain dark things are to be loved,
in secret, between the shadow and the soul.

I love you as the plant that never blooms
but carries in itself the light of hidden flowers;
thanks to your love a certain solid fragrance,
risen from the earth, lives darkly in my body.

I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love you because I know no other way

than this: where I does not exist, nor you,
so close that your hand on my chest is my hand,
so close that your eyes close as I fall asleep.

Translated by Stephen Tapscott

Friday, March 20, 2009

Follow the Money: Scott Reuben, MD

Scott S. Reuben, MD.

Amazingly, I actually knew who he was before the news of his many years of academic fraud recently broke. There are not many authoritative researchers in the field of pain management, in general, and even fewer who further subspecialize in the treatment of CRPS/RSD.

Pain management doctors (most being anesthesiologists), physiatrists, and neurologists all probably refer to his "work" as justification for refusing to treat CRPS pain with opiates, opting instead for some "multimodal" (Dr. Reuben's buzz word) combinations that usually included Lyrica and anti-depressants.

Sad to say, he has "made" Wikipedia due to infamy rather than achievement.

His fabricated results date back to 1996 and did not actually perform *any* of the clinical trials upon which his voluble opinions were based. Colleagues and fellow researchers struggle to understand the reasons for this incredible case of academic dishonesty, named "misconduct"; Really, though, if investigators "follow the money," I am sure Dr. Reuben's reasons will become as clear as they are commonplace to most criminal activity.

One possible avenue of investigation springs readily to mind:

A cornerstone of Dr. Reuben’s approach has been the use of the selective
cyclooxygenase-2 inhibitor celecoxib (Celebrex) and the neuropathic pain agent
pregabalin (Lyrica), both manufactured by Pfizer. Dr. Reuben has received
research grants from the company and is a member of its speakers’ bureau.
However, a source told Anesthesiology News that Pfizer recently alerted its
speakers to remove any reference to Dr. Reuben’s data from their presentations.
Pfizer was unable to comment by the time this article went to press. The company
has not been accused of wrongdoing in the matter.

The extent of his fraud is hard to comprehend. He published influential research for 12 years about clinical trials that he never conducted. (I know I am repeating myself. It is just almost impossible to believe. How did he do it? He cannot have done this alone. Could he?) Decisions about anesthesia protocol and trends in treatment of chronic pain syndromes were based on his "work." He seems to have targeted the orthopedic community above others -- are OS less likely than others to look under rocks, to question the validity of research? I think not! Maybe it is simply that chronic pain is a common result after orthopedic surgery -- from osteoarthritis to CRPS -- and, like any surgery, a short period of acute pain is virtually guaranteed. And since he was purportedly conducting clinical trials, orthopedics would offer a good sized cohort of patients having similar surgeries -- anterior cruciate ligament repairs and other knee surgeries seemed to his liking, as well as amputations and spinal fusions.

In addition to Lyrica and Celebrex, Reuben was pushing Bextra, Effexor, and Vioxx:

The hospital has asked the journals to retract the studies, which reported favorable results from painkillers including Pfizer Inc.'s Bextra, Celebrex and Lyrica and Merck & Co. Inc.'s Vioxx. His studies also claimed Wyeth's antidepressant Effexor could be used as a painkiller. Pfizer gave Reuben five research grants between 2002 and 2007. He was a paid member of the company's speakers bureau, giving talks about Pfizer drugs to colleagues. Reuben also wrote to the Food and Drug Administration, urging the agency not to restrict the use of many of the painkillers he studied, citing his own data on their safety and effectiveness. "Doctors have been using (his) findings very widely," said Dr. Steven Shafer, editor of Anesthesia and Analgesia, a scientific journal that published ten articles identified as containing fraudulent data. "His findings had a huge impact on the field." Paul White, another editor at the journal, estimates that Reuben's studies led to the sale of billions of dollars worth of the potentially dangerous drugs known as COX2 inhibitors, Pfizer's Celebrex and Merck's Vioxx, for applications whose therapeutic benefits are now in question.

This biographic blurb describing Dr. Reuben and his work is frightening to read, knowing the truth:

Scott S. Reuben, MD is Director of the Acute Pain Service and Professor of
Anesthesiology and Pain Medicine at Baystate Medical Center and the Tufts
University School. He performed his anesthesia residency and fellowship in pain
management and regional anesthesia at Mount Sinai Medical Center in New York.
Dr. Reuben has authored over 100 articles and dozens of abstracts in peer reviewed anesthesia, pain medicine, surgery, and orthopedic journals. He has presented his papers and lectured at both the national and international level
speaking on all items of interest for the pain management practitioners and scientists, including acute pain management, pre-emptive analgesia, and the use
of various analgesics to manage pain. Dr. Reuben has served as an advisory board
member for the JCAHO, ASA Task Force for Acute Pain Management, and currently serves as a journal reviewer for Anesthesiology, Anesthesia & Analgesia,
Journal of Pain and Symptom Management, Journal of Clinical Anesthesia, Journal of Bone and Joint Surgery, Arthroscopy, Journal of Pharmacology and Therapeutics, and Lancet. In June of 2007 he authored the Current Concepts Review article in the Journal of Bone and Joint Surgery.
Advisor to JCAHO!

Journal reviewer!

Author of Current Concepts Review!

In a field where one hopes that reproduction of results -- basic to scientific method -- holds sway, how is it that these fictions were allowed to circulate and be emulated for so long? "Peer review" certainly should not be the sole arbiter of validity. Essentially, Reuben's work was rubberstamped by his "peers," or else he served as his own judge, and we see how well that worked out...

How to accurately quantify the amount of pain this man has caused? How many "adverse reactions," how much permanent impairment, how many deaths?

Thursday, March 19, 2009

Potpourri #756

What a day.

I passed out -- that was fun. It's the second time in a week, and several weeks of flirting with it. Actually, I don't think I was out-out. I was just out. Blip. For a second. A weird sense of tunnel vision, then a slight fade to darkness. Each time I was able to sit down. Well, "sit down," is a nice way to put it. More like: I managed to flop backwards.

Today's dive bomb was timely, in that I had an appointment with The Boutiqueur anyway. It almost happened again when I was exiting the car. She's up! She's down!

The Boutiqueur said it sounded like orthostatic hypotension. That makes sense. I guess. Anyway, I am going to try and "hydrate" more and take extra care when standing up. Just what I need, more incentive to stay in the wheelchair.

It actually has been harder and harder to stand and walk, both in terms of pain and in terms of getting my legs to cooperate. I am experiencing "myoclonic jerks" -- no, not flashbacks of the guys I dated in high school, but almost full body violent spasms. A few times now, I have tossed my coffee cup in the air. With any luck, the ceiling over the bed will pass for a Jackson Pollock. Or the shroud of Turin. [If La Bonne et Belle Bianca Castafiore can rake them in to see her faux Francis the First's bedroom, I can go after the stragglers.]

Reminder to self: red wine, Concord grape juice, and some of that V-8 colada mixture. Toss some salsa up there, too.

In between patient phone calls and blood draws at the doctor's office, I thumbed through the latest Newsweek -- Limbaugh on the cover, mouth wide open.

Jacob Weisberg writes a regular column titled "The Big Idea." The big idea for this issue proved to be one that has been giving me headaches (and I don't DO headaches): "The Staying Power of the S Word," or "We're Not Swedish." A version was also published at

The relief I felt while reading it must be similar to what a person with increased intracranial pressure might feel if someone took a power drill to his skull.

Conservatives have finally figured out their critique of president Obama's agenda: he wants to make us French...

Newt Gingrich claims that Obama wants to bring us "European socialism."

"Socialism" is a scare word in our political culture and a poor description both of modern-day Sweden and whatever Obama has in mind. But the case that the United States is moving away from market capitalism, and toward a European-style social compact in which the state has a much broader role, is not absurd. ("We Are All Socialists Now," NEWSWEEK recently proclaimed on its cover.) The Obama administration is responding to the financial crisis by nationalizing financial institutions, subsidizing failing sectors of the economy and, while it's at it, regulating industry to fight climate change. It views greater social equality as an explicit goal. If Obama succeeds in turning health insurance and funding for college into universal entitlements, he will have expanded Washington's obligations on the scale of an LBJ or an FDR. This year, government spending at all levels will jump to 40 percent of GDP. Obama's proposals could bring that figure even closer to the European Union average of 47 percent.

A first question to ask about this expansion is what, exactly, is so awful about
European social democracy? [....]

Such deeply grounded differences explain why the European model of social democracy would be unlikely to find root here, even if the president favored it. But Obama shows every sign of instinctively resisting a paternalistic and overarching public sector as much as most Americans do. His approach to problem-solving reflects the national urge to rein in government even while one is busy expanding it.

This aversion to state control characterizes Obama's response so far to
the financial crisis. When asked in an ABC interview why he hadn't nationalized
the damn banks already, Obama's telling response was to talk about how our
"traditions" and culture are different from Sweden's. "We want to retain a
strong sense of that private capital fulfilling the core investment needs of
this country," he said. Note that Obama's global-warming plan is a market-based,
cap-and-trade system rather than a more straightforward carbon tax or regulatory scheme.

Even in areas where Obama seems to be moving in a more statist direction, there are crucial distinctions. Like most Americans, he believes government should guarantee health insurance. And like most Americans, he believes the system should be privately run. His college plan is for universal access to loans, not the essentially free ride that most students get in the EU. And he looks poised to pare Social Security benefits and Medicare spending, in addition to raising taxes, to constrain the overall cost of government. One way to describe Obama's program is a move toward cradle-to-grave opportunity, as opposed to the European model of cradle-to-grave security.

What was that again? Eh? Would you mind repeating that last little jingle-jangling oh-so-fine turn of a phrase?

A move toward cradle-to-grave opportunity, as opposed to the European model of cradle-to-grave security.

Of course, then I had to go and read the insipid comments after Weisberg's column, not unlike a 50-car highway pile-up. The one currently at the head of the line is by brooklyn486, posted @ 03/18/2009 9:41:07 PM.

What everybody seems to be over looking is the actual textbook
definition of socialism.

The definition os socialism is as follows:
Socialism refers to a broad set of economic theories of social organization advocating public or state ownership and administration of the means of production and distribution of goods, and a society characterized by equality for all individuals, with a fair or egalitarian method of compensation.

In othe words a country is not purely Socialist unless the governement
owns all factories and stores!!!

Study history and you might know a thing or two.

Hey, brooklyn486, wanna hear a joke?

What do Brooklyn and women in tight jeans have in common? Oops. No, not that one.

This one:
Q: Why did the duck go to Brooklyn? A: To buy some quack.

If only you were from Alabama! But then, I bet you hear that all the time.

So I had a fever of 100.9 at the doc's office. It was only 99.6 at home. Split the difference? 100.25? Now... if I could get my heart rate below 108. It's uncomfortable to wake up and find it racing along at 126. I know I should just ignore it but confess that's getting hard to do.

His theory of my ladylike wilting-with-the-vapors: my blood pressure has been abnormally high these past few months, so that when I experience a drop in pressure, standing up, the drop is that much more precipitous. Why is it happening to begin with? He thinks it could be an electrolyte imbalance, but bets more on dehydration. Daily fevers can do that, y'know! Wanting his theories to get as much bang for the thought as possible, he floated that as the reason behind these lovely full-body myoclonic jerks -- What my doctors don't know about CRPS might fill a big old book. Because I know it is a consequence of the CRPS/RSD. Do I know the science behind it? Nope.

"Maybe I could interest you in a hot cup of shut-the-fuck-up..." (Jon Stewart, 3.18.09)
I had to write that down, and now have to find the perfect application for it. Oh, this shall pass into my lexicon. But I have as much a chance of using it as I do of wearing my sapphire blue raw silk très short-skirted suit with a nice pair of red high-heels. (I haven't worn shoes in 7 years and rarely am in anything that isn't entirely old-lady-esque. Sigh.)

Oh, God. Cheney attributes the ever so mild effing up of things under his co-administration to... well, here is the quote:

"Eight months after we arrived, we had 9/11. We had 3,000 Americans killed
one morning by al Qaeda terrorists here in the United States. We immediately had
to go into the wartime mode. We ended up with two wars in Afghanistan and Iraq.
Some of that is still very active. We had major problems with respect to things
like Katrina, for example. All of these things required us to spend money that
we had not originally planned to spend, or weren't originally part of the

"Stuff happens."


Binghamton v. Duke starts around 9:30 tonight. I get the feeling more than one television set may be operational. The Castafiore and I have dibs on the extravagant entertainment center in here... The Fredster can either grin and bear it, snuggling in between all the boobies, or he can go to one of the other 40 or so bedrooms. I think he wants to watch ER -- but gets upset at the idea of recording it. Go figure. Fred's deep. The Ways of Fred are Mysterious. He's a sweetie.

Hark! What's that I hear?

f'blasticball! f'blasticball! allez, dooook-uh! allez, dooook-uh! [shuffle shuffle]
f'blasticball! f'blasticball! allez, dooook-uh! allez, dooook-uh! [shuffle shuffle]

Here she comes. Game on!

Wednesday, March 18, 2009

Slightly Colored Prejudice: Draft 31, Claude Debussy: Homme de Lettres

I made the mistake of deciding to clear out some of the 31 sketchy drafts for elle est belle la seine la seine elle est belle . It has become something of a game, this effort to remember the genesis of each one.

The origin of Claude Debussy: Homme de Lettres is easy to recall. It started with Wikipedia, and my first disappointment in its information. In the section "Early Life and Studies," under the rubrique "Biography," I read:

"[Debussy's] talents soon became evident, and in 1872, at age ten, Debussy entered the Paris Conservatoire, where he spent eleven years. During his time there he studied composition with Ernest Guiraud, music history/theory with Louis-Albert Bourgault-Ducoudray, harmony with Émile Durand, piano with Antoine-François Marmontel, organ with César Franck, and solfège with Albert Lavignac, as well as other significant figures of the era.
From 1880 to 1882, he lived in Russia as music teacher to the children of Nadezhda von Meck, the patroness of Tchaikovsky." (emphasis mine)

I adore Wikipedia and the notion of anonymous hordes happily pecking away at their keyboards, sharing information and personal talents. Recently, I heard a claim that Wikipedia has more than 90% of the online reference action -- more than Columbia Encyclopedia,, Britannica, Encarta...

[[[What a thrill to unexpectedly find that the awesome 1911 edition of Britannica is available online! The-Great-American-Writer, with whom I cohabitated for several particularly painful years, was collecting those volumes, and as his assistant in the process, I fell head over heels in love -- not with him, but with the musty, wondrous encyclopedia.

The folks at LoveToKnow summarize the 1911 edition
like this:

The LoveToKnow Free Online Encyclopedia is based on what many consider to be
the best encyclopedia ever written: the eleventh edition of the Encyclopaedia
Britannica, first published in 1911...

It is not uncommon for its entries to be 5 to 10 times the length of other encyclopedias. As a research tool, this 11th edition is unparallelled - even today. LoveToKnow is now giving you all these thousands of entries, preserving the treasured entries that make it so unique, and where necessary and possible adding the current point of view...

The Eleventh Edition filled 29 volumes and contains over 44 million words. It contains over 40,000 articles written by over 1,500 authors within their various fields of expertise. What was particularly remarkable was that many of the entries were written by the most famous people of the age. As such, it was considered to represent the sum of human knowledge at the beginning of the 20th Century.

Sir Kenneth Clark, in Another Part of the Wood, wrote of the Eleventh Edition:

"One leaps from one subject to another, fascinated as much by the play of mind and idiosyncrasies of their authors as by the facts and dates. It must be the last encyclopedia in the tradition of Diderot which assumes that information can be made memorable only when it is slightly colored by prejudice..."

"Slightly colored by prejudice." Yes.

How do we like our knowledge served up? Straight? On the rocks? With soda, with water? With Coke, Irish cream, Ginger Ale?

I confess (just try and stop me) to having once been an 18th century specialist. I further confess that it was Diderot who enthralled me. Okay, so the Revolution, Voltaire, and the Age of Enlightenment were also partial attractions.

Knowledge slightly colored by prejudice -- that's how I want it.

Like Wikipedia, the 1911 Britannica LoveToKnow project invites reader participation -- certainly not to edit the original, but to update the "facts" of an entry -- beyond the official 1922 addition of materials.

So, yeah...

This draft began with a small goof on Wikipedia. Not a prank -- I enjoy pranks. John Seigenthaler was reported to have been part of assassination conspiracies in the deaths of John and Robert Kennedy, for instance, an entry detail that escaped correction for months. Okay, so it is not laugh-til-you-drop funny, but you get the idea.

Of course, the Siegenthaler incident, itself, became a Wikipedia entry and part of its coopted lore.

A factual goof -- that's different. Right? More truly serious. Knowledge with a capital K.
We all need the illusion that we're getting the Straight Poop from an unimpeachable source, and from that source-work we pretend to elaborate and editorialize. We want to own the information; We want to make it new and thereby be part of a process of perceptual change.

Which is, of course, quite impossible without being able to bring to bear some citation of authority, some fame of our own.

So anyway... WAIT! Hold it right there, reader!

I lied -- but without intention: The origin of "Claude Debussy: Homme de Lettres" was not, in fact, some Wikipedant gaffe. I don't even like Debussy's music or consider him much of an interesting figure. There is no way that one of my searches would travel straight to Debussy...

It all began with Stéphane Mallarmé. And Mallarmé came to mind out of a sense of loss -- a child that I did not know died the day of that composition, February 25. That is how Pour un tombeau d'Anatole became my focus that afternoon.

I blame the leap to Debussy on the Fog of Anesthesia. Yeah, that's it, that's the ticket! I was just about a week out from my last surgery. Yeah, that's right. It was not me that followed an obscure link tying Mallarmé to his compatriot Gide, who eventually introduced Pierre Louÿs into the poet's circle of friends, where Louÿs met and befriended Debussy.

No way do I labor in the shadows of obscurity!

Okay, so they wrote each other; I read some of their letters; I copied and pasted a few from the roundabout train of thought just detailed; C'est tout! Simple comme 'Bonjour'!

So, uh, without further ado, enjoy the wit, share the love-- the initial letter is offered as a carrot, a bribe -- Debussy has arrived in Rome at the sort of "artist's colony" set up at the (in)famous Villa Medici, where the terms of a scholarship (the Prix de Rome) dictate he must stay for three years.

[Dear Reader, you've no idea of the bullet just dodged. The more I research the Villa Medici, and the vagaries of the Prix de Rome, the more I want to write about it. But I promise you that I won't. Probably won't. Could be that I might not.]

Qui savait qu'il eut un cerveau si marrant!

Debussy à Henri Vasnier (début février 1885) Villa Medici
Cher Monsieur Vasnier
M’y voilà dans cette abominable villa. Et je vous assure que ma première impression n’est pas bonne, il fait un temps épouvantable, de la pluie, du vent. Vous m’avouerez qu’il n’était pas besoin de venir à Rome, pour retrouver le même temps qu’à Paris, surtout pour quelqu’un rempli de rancune pour tout ce qui est Romain. Les camarades sont venus nous chercher à Monte Rotonde, dans une sale petite chambre où nous avons couché tous les six. Si vous saviez comme ils sont changés, plus de cette bonne amitié de Paris, ils sont raides, ont l’air convaincu de leur importance, trop pris de Rome ces gens-là. Le soir de mon arrivée à la villa, j’ai joué ma cantate, qui a du succès près de quelques-uns, pas du côté des musiciens par exemple. C’est égal ce milieu artistique dont parlent les vieux, cette bonne camaraderie me semble bien surfaite, à part une ou deux exceptions, il est difficile de causer, et je ne peux m’empêcher de rapprocher près de ces causeries banales vos bonnes et belles causeries qui m’ont tant servi et ouvert l’esprit sur bien des choses, ô oui je les regrette. Puis, tout ce monde-là est parfaitement égoïste, chacun vit pour soi. J’ai entendu les musiciens qui sont, Marty, Pierné, Vidal, se démolir entre eux, Marty avec Pierné démolit Vidal, Pierné avec Vidal démolit Marty, et ainsi de suite. Ah, quand je suis rentré dans ma chambre qui est immense, où il faut faire une lieue pour aller d’un meuble à l’autre, que je me suis senti seul et que j’ai pleuré. J’étais trop habitué à votre amitié si intelligente, trop habitué à ce que vous [vous] occupiez et me parliez de ce que je faisais et je n’oublierai jamais, monsieur, tout ce que vous avez fait pour moi, la place que vous avez bien voulu me faire, dans votre famille. Je ferai tout ce que je pourrai pour vous prouver, que je [ne] suis, pas ingrat. Je vous demanderai encore de ne pas m’oublier, et de me garder la place que j’ai dans votre amitié car je prévois que je vais en avoir bien besoin. J’ai essayé de travailler, je ne peux pas, je fais cependant tout ce que je peux. Vous savez du reste combien j’aime la musique, et pouvez croire combien l’état dans lequel je me trouve, me contrarie, mais je ne peux pas, vivre de cette vie-là, ce qui fait leur joie ne peut faire la mienne, ce n’est pas par orgueil, que [je] la hais tant, non, mais je ne peux m’y habituer, je manque des aptitudes spéciales, et de l’indifférence, qu’il faudrait y mettre. [...] J’ai reçu votre lettre, qui m’a fait beaucoup, beaucoup, de plaisir, et si ce n’est pas trop vous demander, malgré que je sache bien que votre temps ne vous appartient pas, répondez-moi une longue lettre, pour me rappeler les bonnes causeries dont je vous ai parlé. Croyez-moi bien amicalement et bien affectueusement à vous, Votre tout dévoué
A. Debussy

Pierre Louÿs à Debussy [Genève], Vendredi 13 [juillet 1894]
Hé bien ! mon vieux, je n’y ai pas été, à ton Bayreuth de malheur ! Je pars pour Biskra. (Je crois que je te l’ai déjà dit) Veux-tu m’y rejoindre ? Voyage : 430 fr aller et retour en première . 218 fr en seconde et 170 en troisième (toujours aller et retour). Si tu peux grâce à Hartmann, payer le voyage, je t’entretiens à l’oeil pendant deux mois ; tu ne te doutes pas de ce que ça va être épatant. Gide revient de là-bas comme un fou. Je t’attends
Pierre Louÿs.

Debussy à Pierre Louÿs [20 juillet 1894] Vendredi
Cher Ami : Je ne me doutais pas jusqu’ici que le "renversement" de Bayreuth était Biskra, mais Dieu seul sait combien j’aime mieux cet accord-là ! au fond, Bayreuth, est un mauvais enseignement et, c’est un univers un peu borné par l’accord de septième ; combien mieux Biskra, doit nous apprendre des combinaisons nouvelles !
Mais dans cette affaire 
Que devient Wagner ? Et qu’est-ce qui... Biskra ? C’est Cosima.
Ah ! comme je t’envie de pouvoir revêtir des étoffes qui peuvent être trop claires, et comme tu dois avoir l’air anglais parmi toute cette terre cuite. Ici il fait septentrional et voilà que des gens revêtissent des fourrures pour pouvoir croire à un peu de chaleur, et les arbres rentrent leurs feuilles dans leur "portefeuille", on va sûrement être obligé de remplacer l’Eté par un procédé chimique. Enfin ! c’est le triomphe des gens qui ont du sang-froid. Moi je vis dans la seule compagnie de Pelléas et Mélisande, qui sont toujours des petits jeunes gens très accomplis, je me suis décidé à faire la scène de souterrain mais d’une façon que tu me feras le plaisir de trouver curieuse quand tu la verras. - Je dîne avec Robert, qui remplace avantageusement le Tzigane, pendant le dîner, si cela peut te faire plaisir sache que tu me manques, puis personne ne me joue plus du Bach avec cette délicieuse fantaisie que seul tu sais mettre dans ces antiquités 
 Et je suis ton fidèle
Claude Debussy

Debussy à Pierre Louÿs [16 décembre 1900]
Et d’abord merci de ta charmante lettre (merci un peu tardif qui s’excuse d’avoir compté tant de mesures !) - joli ça ! - j’ai décidément trop lu les journaux depuis quelques jours). Des gens m’ont dit que tu étais avec ce bon Bonnières, qu’est-ce que Vincent-et-Moi a bien pu formuler d’éternel ? n’y a-t-il toujours que le reconstituant Bach qui soit capable de lui défriper les méninges ? Et dans la Vie Parisienne d’hier il y a un article tout à fait curieux et macaronique : à ce propos tu serais bien gentil, toi dont le gosier de métal parle toutes les langues, de me dire ce que signifie le mot : "Néphélococcygies". Est-ce une insulte ou le nom d’une nouvelle maladie ? Ai-je besoin de te dire que Lilly et moi envoyons des affectueux souvenirs à Madame Pierre Louÿs et que je suis ton vieux dévoué

Monday, March 16, 2009

What's Your Pain Care Philosophy?

Because I read WhiteCoat's Call Room blog, I do what I do at most blogs -- inadvertently click on the wrong thing.

This time, though, I was happy where I landed: a column entitled "What's Your Pain Care Philosophy?" by Greg Henry, MD, part of the many interesting offerings in the Emergency Physicians Monthly.

Don't worry. I make sure to only understand what the average layperson "ought"! (Medicos are invested in everyone else being uninformed... Distribution of knowledge might set off a nasty case of Socialism!)

First that problem that I think everyone, from the person in pain to the healthcare professionals to the local pharmacist, recognizes as a problem: the pain scale.

"The first area that I’d like to comment on is the pain score. This seems to be a holy grail for administrative types and those running institutions like the Joint Commission. If there’s ever been less science in medicine, I’d like to see it pointed out," writes Henry.

He concludes, as other medical bloggers have, that what may be useful is to consider the patient's degree of change from the pain's "norm." Last July, Scalpel or Sword wrote a piece proposing "the Delta P," a consideration of change in pain from baseline. This makes enormous sense, and we patients would appreciate the clarity, too.

Next, Henry turns to the issue of drug-seeking, certainly the most cited bête noire of ER/ED workers. It is a heavy onus we place on ER/ED workers, doctors and nurses, alike. We want prompt and perfect care, delivered with compassion and sincerity. We want it all. Now.

It truly is an impossible burden and I understand the rancor that frequently inhabits the blogs of these healthcare professionals. I think Dr. Henry explains things well, even if he can barely scratch the surface in such a short piece. He is starting an interesting conversation:

"[T]here is no hot button in emergency medicine like the evil term 'drug seeker.' It absolutely clouds our thinking about the patient and their problems. As soon as the label of 'drug seeker' has been applied by the staff, all intelligent inquiry stops. We start to put up a wall, really for no good reason. It is always interesting to talk to physicians about whether they had a 'good shift' or a 'bad shift.' It almost never has anything to do with the actual disease entities that were presented. Often, it’s directly related to the number of patients they thought 'really didn’t need pain medication.' I think that we put far too much stress upon ourselves when we start to feel that we are the gatekeeper to pain medications. It is interesting to note that when a patient comes back to the emergency department with recurrent pain, we refer to them as a drug seeker. We don’t refer to a patient with asthma who has come back for more treatment as an 'oxygen seeker.' Exactly why is this a problem? I think to a great degree the personalities involved. Physicians and nurses are, by definition, type A personalities who do all, bear all, go through all, without whining or complaint. We long for the era of wooden ships and iron men when patients were grateful for care and kept their mouths shut. Anyone who has significant pain not relieved on the first attempt probably doesn’t deserve our care. This mentality becomes cyclical and frightening."

He raises the spector of racial bias, noting that studies show that pain relief is less likely to be afforded certain ethnic types and not others, calling this a "black mark on the profession."

The complicated issue of drug addiction, which Henry recognizes as an "ubiquitous problem in this country," cannot be addressed in the emergency department. Some of the more morally imperious will accuse him of being part of the problem, and complacent.

"Whenever I wonder whether I should or shouldn’t be giving a dose of pain medication, I always remember this: I’ve never created an addict by giving one shot of pain meds, and I’ve never cured an addict by withholding it. These are complex issues and I can’t always sort them out in the emergency department. There’s no question that there’s heavy pressure from the nursing staff to deny certain patients medication. The snide comment that 'you’re not going to give them pain medicine, are you, Doctor?' has, more than once, intimidated and dissuaded otherwise compassionate physicians from acting. My philosophy on this is simple. I’d rather treat ten patients who don’t really need the pain medicine than deny the one patient who really does."

I hope others will join in the conversation.

The Bering Strait Bridge

Very strange and totally unexpected, this. That my political will should find its voice again and finally slough off the dead weight of the malignant illogical who have dominated discourse for so long: hate-mongers, and shrill, every last one of them, fostering straw argument upon intended lack of clarity, and through pure laziness and underestimation of audience, linking unlike to unlike, as if the rejection of one entailed the necessary rejection of the other.

Parse *that*, my friends.

Friggin' obfuscators. But, you know, at worst, obfuscators waste my time.

Piety in rhetoric is the real cagey beast -- is, in fact, most often a downright out-and-out shitty rhetorical device.

I challenge you. Think of a person of your acquaintance whom you'd qualify as "pious." Now, are you having warm fuzzies or are you feeling a wee bit disgusted -- either with said person or with your own hypocritical self?

I'm just sayin'.

To keep myself in check, for you must concur that I'm on the edge of discourtesy, I had recourse to A List Of Fallacious Arguments -- from which the following is a citation:

In the context of debates, a Pious Fraud could be a lie. More generally, it would be when an emotionally committed speaker makes an assertion that is shaded, distorted or even fabricated. For example, British Prime Minister Tony Blair was accused in 2003 of "sexing up" his evidence that Iraq had Weapons of Mass Destruction.

Around the year 400, Saint Augustine wrote two books, De Mendacio[On Lying] and Contra Medacium[Against Lying], on this subject. He argued that the sin isn't in what you do (or don't) say, but in your intent to leave a false impression.

As much as I would love to talk, discuss, and debate salient points of socialism/Socialism or Democratic, Republican, and Libertarian sensibilities -- for I would be in a position to learn a lot, and want to, too -- I can no longer stomach the clinging, dangling, desperate dingleberries posited by some right wing journalists and bloggers -- those cozy little pearls of turds in the middle of what might have been an honest communication...

William Bradley wrote a piece today for, making reference to the recent reign of bombasters and generally blowing off steam. All citizens of good political will need to get this crap out of their collective and individual systems. Open the window and scream that you aren't going to take it anymore.

CNBC can see Russia from its house. It's just one example of a fin de siècle
folly, albeit one of the most recent and dramatic.

This is clearly end-of-an-era time, but some of the old era standbys haven't gotten the memo. Or been able to read it.

Jon Stewart's already legendary takedown of the CNBC financial "news" network was an extraordinary rebuke of a fitting stand-in for a clueless money culture.

It should have been obvious the era was ended with the worst economic crisis since the 1930s, not to mention the sweeping victory of Barack Obama. But the old attitudes -- which represent a sort of intellectual entropy -- have been very persistent.

He goes on to mention Sarah Palin, Rush Limbaugh, Michael Steele, Katon Dawson, even Joe the Plumber.

I hope he feels better.
I am beginning to.
It doesn't hurt to state the obvious; Certainly, I need iteration upon iteration when asked to absorb what I don't like (or almost anything, actually).

Constant repetition of lies has been this nation's steady diet for eight years. Its cunning simplicity is genius. Witness the Dick Cheney Show on CNN yesterday.

Cheney, against all odds and normal perceptions of reality, still insists that things went great for the past eight years. He and George W. Bush bear no responsibility for the near-meltdown of the financial system. Their policies of torture kept America safe and strong, notwithstanding the general unreliability
of torture as a means of interrogation, or the international opprobrium it brought America. Oh, and the Iraq adventure, which has kept the Americanmilitary pinned down for six years and empowered Iran? A smashing success.

He sees Russia from his house, too.

Sunday, March 15, 2009

Keep in your life

"Try to keep into life. Don't give up. Keep in your life.
It is destructive to give up."
-- Dr. Robert Schwartzman, re: best defense against CRPS/RSD