The third way in which the Mickey Mouse sign can show up in
medicine is via ultrasound scanning in the detection of anencephaly.
Anencephaly is the absence of a large part of the brain and the skull. It is the
most common abnormality affecting the central nervous system (brain and spine).
Most babies born with this condition do not survive birth. The picture below (copyrighted by Wiley from this article) shows
the appearance of a Mickey Mouse face on the ultrasound. In reality, it is
showing a large amount of protruding, abnormally developed brain tissue. The
sign was first identified in 1994 and its presence helps diagnose anencephaly
early in pregnancy. Be sure to check out the first Mickey Mouse sign, the second Mickey Mouse sign, and the fourth Mickey Mouse sign.
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Monday, March 26, 2012
Friday, March 23, 2012
The Mickey Mouse Sign in Medicine: Part 2
Today is the 2nd example of The Mickey Mouse sign in the field of medicine. What you will see in the picture below is an image from a coronary angiography of a 58-year-old man presented in this article. An angiography is a technique that produces a picture of the inside structure of blood vessels. You will see two large black circles shaped like Mickey Mouse ears, which is an aneurysm. An aneurysm is a balloon-like expansion of a blood vessel due to weakening of the blood vessel walls. Be sure to also see part one, part three, and part four of the Mickey Mouse sign.The image below is copyrighted by the American Heart Association.
Thursday, March 22, 2012
The Mickey Mouse Sign in Medicine: Part 1
Mickey Mouse was created by Walt Disney in 1928. His impact has been felt all over the world, including the field of medicine. If you have children, your pediatrician’s office likely has pictures of Mickey to make it more comforting. For the same reason, pediatric nurses often wear Mickey on their clothes, children are sometimes given Mickey Mouse stickers, and Mickey Mouse cartoons may be playing in the waiting room. But beyond the obvious use of Mickey Mouse in pediatric medicine, Mickey Mouse has managed to show up in various images of the body, all of which are referred to as Mickey Mouse signs. In the next four blog entries (excepting the MedFriendly Blog contest over the weekend), I will provide four examples of the Mickey Mouse sign in medicine.
Case 1 involves a 55-year-old woman with breast cancer who underwent a bone scan to determine if the cancer had spread to the bones. In the picture of the spinal area below, the Mickey Mouse sign is the black area seen in the 2nd lumbar vertebrae (lower back). The black pattern of three dots shows areas in which the injected radiotracer was absorbed by the bone. The finding was consistent with Paget’s disease, which is a form of chronic bone inflammation and rapid bone destruction that distorts the bone structure. As a result, unusual patterns can present on bone scan images, including the Mickey Mouse sign. Come back tomorrow to see another Mickey Mouse sign. The image below was featured in this free article and is copyrighted by the Society of Nuclear Medicine. Be sure to see part two, part three, and part four of the Mickey Mouse sign.
Case 1 involves a 55-year-old woman with breast cancer who underwent a bone scan to determine if the cancer had spread to the bones. In the picture of the spinal area below, the Mickey Mouse sign is the black area seen in the 2nd lumbar vertebrae (lower back). The black pattern of three dots shows areas in which the injected radiotracer was absorbed by the bone. The finding was consistent with Paget’s disease, which is a form of chronic bone inflammation and rapid bone destruction that distorts the bone structure. As a result, unusual patterns can present on bone scan images, including the Mickey Mouse sign. Come back tomorrow to see another Mickey Mouse sign. The image below was featured in this free article and is copyrighted by the Society of Nuclear Medicine. Be sure to see part two, part three, and part four of the Mickey Mouse sign.
Wednesday, March 21, 2012
Why Kermit the Frog Rules
Kermit the Frog is the undisputed leader of the Muppets and his presence dates back to 1955. He’s the only Muppet to be featured prominently of The Muppet Show and Sesame Street. Kermit the Frog is used here as a symbol for all sorts of frogs (and toads), which play an important role in medical science. If you think back to middle school or high school, you likely had to dissect a frog in science class to learn about different parts of the body. For many children, this spurred further interest in the inner workings of the body and turned many on to the biological sciences.
Observations of frog deaths and body malformations in frogs have been taken by some to be warnings of possible environmental effects on humans. Scientists have also genetically engineered headless tadpoles, which led to speculation that headless people may be genetically created in the future for organ donation harvest. Frogs have been used to study the effects of space flight, which include changes in the lungs, tails, growth, and behavior. Although frogs may sound like perpetual victims (it’s not easy being green), they are actually a resilient species, being one of the unexpected survivors from the Mt. St. Helens volcanic eruption. In fact, the western toad experienced a population boom there because they fed of the algae that resulted from the lack of lakeshore trees and because their predators (snakes and birds) had not yet recovered. The findings helped ecologists better understand the resilience of some species and ways that some species can survive natural disasters. Yes, folks, Kermit the Frog truly rules and science owes him a lot.
If you liked this entry, you may also like Cookie Monster is Not Autsitic
Reference: Am J Med Genet. 2001 Nov 22;104(2):99-100. Is Kermit the frog in trouble? Cohen MM Jr
Observations of frog deaths and body malformations in frogs have been taken by some to be warnings of possible environmental effects on humans. Scientists have also genetically engineered headless tadpoles, which led to speculation that headless people may be genetically created in the future for organ donation harvest. Frogs have been used to study the effects of space flight, which include changes in the lungs, tails, growth, and behavior. Although frogs may sound like perpetual victims (it’s not easy being green), they are actually a resilient species, being one of the unexpected survivors from the Mt. St. Helens volcanic eruption. In fact, the western toad experienced a population boom there because they fed of the algae that resulted from the lack of lakeshore trees and because their predators (snakes and birds) had not yet recovered. The findings helped ecologists better understand the resilience of some species and ways that some species can survive natural disasters. Yes, folks, Kermit the Frog truly rules and science owes him a lot.
If you liked this entry, you may also like Cookie Monster is Not Autsitic
Reference: Am J Med Genet. 2001 Nov 22;104(2):99-100. Is Kermit the frog in trouble? Cohen MM Jr
Tuesday, March 20, 2012
10 Ways to Mismanage Your Patient's Heallthcare
Below is a satirical and easy to follow recipe to quickly and easily mismanage your patient’s healthcare. By following these steps, you too will be able to conceptualize cases improperly, misdiagnose people, and order improper treatments.
STEP 1: Overbook your patients: Schedule so many patients each day that you cannot possibly spend ample time with them or see them back for timely follow-ups. This step is not essential, but doing so allows the next steps to occur more easily.
STEP 2: Do not take a thorough history: Although a patient’s history usually provides essential clues to properly conceptualize cases, ignoring important aspects of the history such as family medical/psychiatric history, personal psychiatric history, history of substance abuse, and history of trauma helps get the interviews done faster so you can move on to the next patient. These topics are the easiest to discard because they are the most uncomfortable to discuss, despite the potential value they provide in understanding the current patient presentation. Do not obtain the patient’s medical records because this takes too much time as opposed to only relying on self-report.
STEP 3: Do not use any objective criteria for diagnosis: The diagnostic process is much faster and easier when relying purely on clinical intuition as opposed to a combination of intuition with objective diagnostic criteria. Doing so requires no standard and allows you to diagnose all sorts of conditions purely because you say so. This step also allows you to make up your own name for some medical conditions.
STEP 4: Prescribe unproven treatments: With no solid foundation for a proper diagnosis, you are now ready to move on to the step which involves prescribing medications, therapies, and use of various medical devices and techniques that have little to no scientifically validated evidence to support their use. If a proven treatment is available, ignore that and use the unproven one.
STEP 5: Do not coordinate care with other medical providers: If your patient is followed by multiple physicians, make no attempt to account for the patient’s numerous medications and the ways in which taking one can interfere with another or cause various adverse reactions.
STEP 6: Make no attempt to objectively measure treatment progress: Once the treatment is selected, keep it ongoing indefinitely and do not use objective measures it to check if it is successful. Simply rely on patient self-report and maintain the same general treatment approach if symptoms are still endorsed. Having no criteria for discharge is a bonus here.
STEP 7: Never alter case conceptualization: Once an initial diagnosis is settled upon (see step 3) do not alter it even if symptoms are reported indefinitely. Do not try to gather new information to figure out why this is happening but if new information arises, simply ignore it if it does not comport with the original diagnosis. Continue with the prior steps.
STEP 8: Do not refer to specialists: Since you already know the diagnosis and proper treatment, do not send the patient for evaluation by a specialist for a second opinion. This is the worst thing you can do because it may lead to an altered case conceptualization or different treatment approach. This is especially true if the specialist uses objective scientific approaches to patient care. The only exception to this rule is if you know of a specialist(s) who always agrees with you.
STEP 9: Make no attempt to measure symptom validity: Trust all subjective symptoms as accurate and make no attempt to measure (or refer to someone who can measure) symptom under-reporting or over-reporting in cases where the context would indicate it is appropriate to do so. Thus, if a patient has a severe medical problem but denies significant symptoms and wants to be released for certain activities, do this without considering reasons for why this may be the case (e.g., poor insight in a possible dementia case; desire to be normal again). Similarly, if a patient suffered a mild medical problem but reports severe symptoms grossly disproportionate to the event, make no attempt to assess for (or refer to someone who can assess for) why this may be the case (e.g., exaggeration to obtain medication and/or compensation benefits).
STEP 10: Do not keep up with the scientific literature or just ignore it: This step allows you to remain unaware of new scientific developments and maintain one’s accustomed way of doing things. If you become aware of research that suggests you should consider a different diagnostic and treatment approach, ignore it and continue with the old approach.
STEP 1: Overbook your patients: Schedule so many patients each day that you cannot possibly spend ample time with them or see them back for timely follow-ups. This step is not essential, but doing so allows the next steps to occur more easily.
STEP 2: Do not take a thorough history: Although a patient’s history usually provides essential clues to properly conceptualize cases, ignoring important aspects of the history such as family medical/psychiatric history, personal psychiatric history, history of substance abuse, and history of trauma helps get the interviews done faster so you can move on to the next patient. These topics are the easiest to discard because they are the most uncomfortable to discuss, despite the potential value they provide in understanding the current patient presentation. Do not obtain the patient’s medical records because this takes too much time as opposed to only relying on self-report.
STEP 3: Do not use any objective criteria for diagnosis: The diagnostic process is much faster and easier when relying purely on clinical intuition as opposed to a combination of intuition with objective diagnostic criteria. Doing so requires no standard and allows you to diagnose all sorts of conditions purely because you say so. This step also allows you to make up your own name for some medical conditions.
STEP 4: Prescribe unproven treatments: With no solid foundation for a proper diagnosis, you are now ready to move on to the step which involves prescribing medications, therapies, and use of various medical devices and techniques that have little to no scientifically validated evidence to support their use. If a proven treatment is available, ignore that and use the unproven one.
STEP 5: Do not coordinate care with other medical providers: If your patient is followed by multiple physicians, make no attempt to account for the patient’s numerous medications and the ways in which taking one can interfere with another or cause various adverse reactions.
STEP 6: Make no attempt to objectively measure treatment progress: Once the treatment is selected, keep it ongoing indefinitely and do not use objective measures it to check if it is successful. Simply rely on patient self-report and maintain the same general treatment approach if symptoms are still endorsed. Having no criteria for discharge is a bonus here.
STEP 7: Never alter case conceptualization: Once an initial diagnosis is settled upon (see step 3) do not alter it even if symptoms are reported indefinitely. Do not try to gather new information to figure out why this is happening but if new information arises, simply ignore it if it does not comport with the original diagnosis. Continue with the prior steps.
STEP 8: Do not refer to specialists: Since you already know the diagnosis and proper treatment, do not send the patient for evaluation by a specialist for a second opinion. This is the worst thing you can do because it may lead to an altered case conceptualization or different treatment approach. This is especially true if the specialist uses objective scientific approaches to patient care. The only exception to this rule is if you know of a specialist(s) who always agrees with you.
STEP 9: Make no attempt to measure symptom validity: Trust all subjective symptoms as accurate and make no attempt to measure (or refer to someone who can measure) symptom under-reporting or over-reporting in cases where the context would indicate it is appropriate to do so. Thus, if a patient has a severe medical problem but denies significant symptoms and wants to be released for certain activities, do this without considering reasons for why this may be the case (e.g., poor insight in a possible dementia case; desire to be normal again). Similarly, if a patient suffered a mild medical problem but reports severe symptoms grossly disproportionate to the event, make no attempt to assess for (or refer to someone who can assess for) why this may be the case (e.g., exaggeration to obtain medication and/or compensation benefits).
STEP 10: Do not keep up with the scientific literature or just ignore it: This step allows you to remain unaware of new scientific developments and maintain one’s accustomed way of doing things. If you become aware of research that suggests you should consider a different diagnostic and treatment approach, ignore it and continue with the old approach.
Monday, March 19, 2012
Friday, March 16, 2012
March Madness, Syracuse vs UNC Asheville, & the Science of Referee Bias
Tonight, during March Madness, the main story was about the
game between the #1 seed in the East (Syracuse) and the #16 team, UNC
Asheville. As a disclaimer, I am a HUGE Syracuse
fan (LET’S GO ORANGE). Besides the possibility of the near upset that took
place, the biggest aspect of the story was several calls by the referee that
went against UNC Asheville that helped Syracuse.
This included a no goal tending call when goal tending seemed to take place, a lane violation call towards the end of the game that actually was correct, and the referees giving the ball back to UNC Asheville after the ball bounced off of Syracuse player, Brandon Triche, followed by a UNC Asheville player hitting into him. There was some question as to whether Triche was fouled before the ball went off of him, causing him to go out of bounds.
This included a no goal tending call when goal tending seemed to take place, a lane violation call towards the end of the game that actually was correct, and the referees giving the ball back to UNC Asheville after the ball bounced off of Syracuse player, Brandon Triche, followed by a UNC Asheville player hitting into him. There was some question as to whether Triche was fouled before the ball went off of him, causing him to go out of bounds.
Ok, so what does all of this have to do with anything medical
you ask? Good question. Nothing. But MedFriendly is a site that not only
explores medical topics but psychological topics as well. Part of psychology is
the study of bias. Some UNC Asheville fans believe that the officials were
biased against them, which is what resulted in the calls above.
So, I tried to see if anyone had explored the notion of officiating
bias scientifically in college basketball. I found one study, performed in 2009.
The study examined officiating bias (in terms of foul calls) in 365 NCAA basketball games
during the 2004-2005 season. Results indicated that officials are more likely
to call fouls on the team with the fewest fouls, making it likely that the
number of fouls will tend to even out during the game. The greater the
difference of fouls between the two teams, the higher the probability that a
foul would be called against the team with fewer fouls. The researchers found a
significant bias towards officials calling more fouls on the visiting team (probability
as high as 70%), and a bias towards foul calls on the team that is leading.
All in all, the evidence indicates that there was not bias
against UNC Asheville by the referees because they met all conditions in the
study by which one would expect bias to be in their favor as opposed to Syracuse. That is, they
were losing at the time, had less fouls (Syracuse
was in the bonus), and technically were considered the visiting team on a neutral
court due to their lower seed and greater distance from their home geographical
location. Ok Syracuse.
Now go beat K-State!
Thursday, March 15, 2012
American Idol, Coca-Cola, and Obesity
So, I am sitting at home and the popular show American Idol is on.
Randy Jackson has a red shirt on, which is color coordinated with a
large red Coca-cola cup. J-Lo is sitting by his side, also with a red
Coca-Cola cup. Same with Steven Tyler. When one of the artists takes
the stage, there is a large red moving video banner promoting Coca-Cola.
It’s called product placement and it has been going on for decades on
television and the movies. There is nothing wrong with it of course, but
in the case of Coca-Cola, the situation gets a little more interesting
because some worry that such advertising may be contributing to the obesity problem in children.
In 2011, researchers from the Rudd Center for Food Policy and Obesity in New Haven, CT, published a study examining the number of food, beverage, and restaurant brand appearances within shows during prime-time programming examined by Nielsen in 2008. Items were analyzed by product category and company as well as exposure to children adolescents, and adults. They found that food, beverage, and restaurant brands appeared 35,000 times prime-time TV programming (60% of which were energy/sports drinks). It was noted that young people were rarely exposed to this type of advertising with on exception…
“Coca-Cola products were seen 198 times by the average child and 269 times by the average adolescent during prime-time shows over the year, accounting for 70% of child exposure and 61% of adolescent exposure to brand appearances. One show, American Idol, accounted for more than 95% of these exposures… Coca-Cola has pledged to refrain from advertising to children, yet the average child views almost four Coke appearances on prime-time TV every week. This analysis reveals a substantial, potential loophole in current food industry self-regulatory pledges to advertise only better-for-you foods to children.”
While this may make it sound like Coca-Cola has violated their pledge, they really have not when you read their pledge carefully. Here is the relevant section:
“…we are committed not to directly market messages for any of our beverages to children under 12. We have historically not placed – and continue the practice today of not placing – advertising for any of our beverages on any media that is primarily directed to, and has an audience of 50% or more, children under the age of 12.”
First, as you can see, it is not correct to say that Coca-Cola has pledged to not advertise to “children.” Rather they pledged not to directly market their products to children under 12 with a specific audience make-up. Secondly, I do not see how one can make the argument that a few Coca-Cola cups and a Coca-Cola banner on American Idol would be directly marketing to children. Direct marketing to children would be showing Bert and Ernie chugging down a Coca-Cola after singing the alphabet or Sponge Bob and Patrick singing about how good Coca-Cola tastes when paired with a Krabby Patty.
Third, American Idol, which was singled out in the study, gets about 25 million viewers. Of these, about 2 million are estimated to be in the 2-11 age range. That’s 12.5% in that age range which is far from the 50% number in the Coca-Cola pledge. Lastly, for other prime time TV shows, young children will not make up more than 50% of the demographic group because the shows are on too late at night. This is why children’s programming is predominant in the morning and the day. All in all, it seems to me that Coca-Cola has maintained their pledge and has not exploited any type of loophole.
In 2011, researchers from the Rudd Center for Food Policy and Obesity in New Haven, CT, published a study examining the number of food, beverage, and restaurant brand appearances within shows during prime-time programming examined by Nielsen in 2008. Items were analyzed by product category and company as well as exposure to children adolescents, and adults. They found that food, beverage, and restaurant brands appeared 35,000 times prime-time TV programming (60% of which were energy/sports drinks). It was noted that young people were rarely exposed to this type of advertising with on exception…
“Coca-Cola products were seen 198 times by the average child and 269 times by the average adolescent during prime-time shows over the year, accounting for 70% of child exposure and 61% of adolescent exposure to brand appearances. One show, American Idol, accounted for more than 95% of these exposures… Coca-Cola has pledged to refrain from advertising to children, yet the average child views almost four Coke appearances on prime-time TV every week. This analysis reveals a substantial, potential loophole in current food industry self-regulatory pledges to advertise only better-for-you foods to children.”
While this may make it sound like Coca-Cola has violated their pledge, they really have not when you read their pledge carefully. Here is the relevant section:
“…we are committed not to directly market messages for any of our beverages to children under 12. We have historically not placed – and continue the practice today of not placing – advertising for any of our beverages on any media that is primarily directed to, and has an audience of 50% or more, children under the age of 12.”
First, as you can see, it is not correct to say that Coca-Cola has pledged to not advertise to “children.” Rather they pledged not to directly market their products to children under 12 with a specific audience make-up. Secondly, I do not see how one can make the argument that a few Coca-Cola cups and a Coca-Cola banner on American Idol would be directly marketing to children. Direct marketing to children would be showing Bert and Ernie chugging down a Coca-Cola after singing the alphabet or Sponge Bob and Patrick singing about how good Coca-Cola tastes when paired with a Krabby Patty.
Third, American Idol, which was singled out in the study, gets about 25 million viewers. Of these, about 2 million are estimated to be in the 2-11 age range. That’s 12.5% in that age range which is far from the 50% number in the Coca-Cola pledge. Lastly, for other prime time TV shows, young children will not make up more than 50% of the demographic group because the shows are on too late at night. This is why children’s programming is predominant in the morning and the day. All in all, it seems to me that Coca-Cola has maintained their pledge and has not exploited any type of loophole.
Wednesday, March 14, 2012
March Madness Associated Deep Vein Thrombosis
March Madness officially started last night. In fact, as I am typing this I am watching Iona take on BYU (great comeback BYU!). This is a great time of year for any college basketball fan because you have several days in which most of the time is taken up with continuous games. This means lots of opportunity to sit or lay down for prolonged time periods. Remaining immobile for long time periods, however, can cause deep vein thrombosis (DVT), which is clot formation in a deep vein. If this clot dislodges, it can be fatal in about 3% of cases in which the clot came from the lower extremity.
While DVT formation can be caused by any form of prolonged inactivity, one group of clinicians at Walter Reed Army Medical Center reported a case of March Madness associated DVT formation in an 83-year-old man. One of the signs of a DVT is edema (swelling), which was first noticed in this man after a full day of sitting and watching March Madness. He had recurrent prostate cancer which was felt to be contributory to the DVT, but that prolonged sitting from watching March Madness was a significant contributory factor to clot formation. Patients with a hypercoaguable state (blood disorder leading to clot formation) increases the risk further. The authors recommended the following steps to prevent DVT formation: decreased alcohol and caffeine intake, drinking a liberal amount of water and fluids, and standing at regular intervals to stretch and promote circulation.
Reference: South Med J. 2005;98(3):396. March madness-associated deep vein thrombosis. Wilson RL, Ritter JB, Roy MJ
While DVT formation can be caused by any form of prolonged inactivity, one group of clinicians at Walter Reed Army Medical Center reported a case of March Madness associated DVT formation in an 83-year-old man. One of the signs of a DVT is edema (swelling), which was first noticed in this man after a full day of sitting and watching March Madness. He had recurrent prostate cancer which was felt to be contributory to the DVT, but that prolonged sitting from watching March Madness was a significant contributory factor to clot formation. Patients with a hypercoaguable state (blood disorder leading to clot formation) increases the risk further. The authors recommended the following steps to prevent DVT formation: decreased alcohol and caffeine intake, drinking a liberal amount of water and fluids, and standing at regular intervals to stretch and promote circulation.
Reference: South Med J. 2005;98(3):396. March madness-associated deep vein thrombosis. Wilson RL, Ritter JB, Roy MJ
Tuesday, March 13, 2012
MedFriendly Website Recommendation #1: The Khan Academy
Tonight I stumbled across a very cool non-profit educational website that I wanted to share with you. It’s called The Khan Academy. Although it may sound like a place you send someone to learn karate, it is actually a website filled with thousands of micro lectures via video tutorials. The topics are very broad and include healthcare, medicine, biology, chemistry, and organic chemistry.
Examples of lectures in healthcare and medicine include one on diabetes, normal colon tissue, colon cancer, vitamin C, and drug pricing. There are many other topics covered outside of healthcare as well including math, the humanities (e.g., history, finances), and much more. The site is funded by donations, such as from Google and the Bill and Melinda Gates Foundation. So check out the site and I think you will find it a worthy bookmark.
Monday, March 12, 2012
Daylights Savings Time & Fatal Car Accidents
This weekend was daylights savings time, the one everyone
dreads because you lose an hour of sleep. Sometimes, daylights savings time
comes as a surprise to people who forgot about it or who did not realize it was
coming.
Some people may know it is coming and adjust their clocks appropriately, but still wake up late because their bodies have yet to adjust. One potential risks of sleep disruption from spring daylights savings time is fatal car accidents. In the fall, you gain the much beloved one extra hour of sleep. There is some evidence for increased and decreased numbers of car accidents after fall daylights savings time. Increased car accidents after fall daylights savings time may be due to staying up longer than usual. Decreased car accidents after fall daylights savings time may be due to some people sleeping an extra hour that night.
An interesting study was performed in 2001 to examine the association between daylights savings time and fatal car accidents in more detail. The researchers examined data from 21 years of United States' fatal automobile accidents. The average number of accidents on the days at the time of daylights saving time shifts (Saturday, Sunday and Monday) was compared to the average of accidents on the matching day of the weeks before and after the shift. This was repeated for each daylights saving time shift.
The results of the study showed that there was a significant increase in accidents for the Monday immediately following the spring shift to daylights savings time. There was also a significant increase in number of accidents on the Sunday of the fall shift from daylights savings time. No significant changes were observed for the other days.
The authors concluded that sleep deprivation on the Monday following a shift to spring daylights savings time results in a small increase in fatal accidents. For fall daylights savings time, the authors concluded that the behavioral changes associated with anticipating the longer day on Sunday led to an increased number of accidents. This suggested an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy.
The authors recommended that public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. The authors concluded that physical and behavioral responses of the body to forced circadian rhythm changes (the body’s biological clock) due to daylights savings changes are important factors for sleep clinicians to be aware of.
Suggested reading: Daylight Savings Time Change May Increase Heart Attack Risk.
Reference: Varughese,J., Allen, R. (2001). Fatal accidents following changes in daylight savings time: the American experience. Sleep Med., 2(1):31-36.
Some people may know it is coming and adjust their clocks appropriately, but still wake up late because their bodies have yet to adjust. One potential risks of sleep disruption from spring daylights savings time is fatal car accidents. In the fall, you gain the much beloved one extra hour of sleep. There is some evidence for increased and decreased numbers of car accidents after fall daylights savings time. Increased car accidents after fall daylights savings time may be due to staying up longer than usual. Decreased car accidents after fall daylights savings time may be due to some people sleeping an extra hour that night.
An interesting study was performed in 2001 to examine the association between daylights savings time and fatal car accidents in more detail. The researchers examined data from 21 years of United States' fatal automobile accidents. The average number of accidents on the days at the time of daylights saving time shifts (Saturday, Sunday and Monday) was compared to the average of accidents on the matching day of the weeks before and after the shift. This was repeated for each daylights saving time shift.
The results of the study showed that there was a significant increase in accidents for the Monday immediately following the spring shift to daylights savings time. There was also a significant increase in number of accidents on the Sunday of the fall shift from daylights savings time. No significant changes were observed for the other days.
The authors concluded that sleep deprivation on the Monday following a shift to spring daylights savings time results in a small increase in fatal accidents. For fall daylights savings time, the authors concluded that the behavioral changes associated with anticipating the longer day on Sunday led to an increased number of accidents. This suggested an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy.
The authors recommended that public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. The authors concluded that physical and behavioral responses of the body to forced circadian rhythm changes (the body’s biological clock) due to daylights savings changes are important factors for sleep clinicians to be aware of.
Suggested reading: Daylight Savings Time Change May Increase Heart Attack Risk.
Reference: Varughese,J., Allen, R. (2001). Fatal accidents following changes in daylight savings time: the American experience. Sleep Med., 2(1):31-36.
Friday, March 09, 2012
Pink Slime in Your Children's Hamburgers
One of my favorite shows on TV is “Good Eats” with Alton Brown. If you have not seen the show, he focuses a half hour episode on a particular food product and he teaches you how to prepare certain meals from it along with interesting historical and scientific tidbits. Last weekend, I tuned into a show he did on hamburgers. He showed a very easy way to make your own burgers by purchasing fresh cuts of beef and grinding it yourself. If that sounds too time consuming, it isn't because you can easily do it with 10 pulses in the food processor. If you grind the beef yourself, you can feel much more comfortable about what is in your burger as opposed to purchasing the beef in an already ground up form.
The reason the above is important is because I have recently become revolted by the revelation that most ground beef products humans are eating (primarily from fast food restaurants) contain something known as “pink slime.” Pink slime (see above) is a nick name for a filler substance made from previously inedible cuts of beef that are made edible through a spinning separation process that involves treatment with water and ammonia. I used to add ammonia to a mop bucket and hot water when I mopped floors as a kid. It is not something that should ever be added to food. I used to think that I could trust the ingredients label on the package to know what was in my food, but as it turns out when pink slime is used, it is not listed and neither is the ammonia present. This is because the FDA does not view ammonia as an ingredient but part of a “process.” This makes no sense whatsoever because all cooking is a process and if a substance is being added to my food, especially if it is a chemical, I want to know about it. This is why I have dramatically changed my eating habits and that of my children after writing the blog entry called: Does Your Kids Cereal Contain BHT or BHA? – Mine Did.
Fortunately, many fast food chains now say that they are pulling “pink slime” from their food products. Unfortunately, many school cafeterias are still serving it to children and they use it as a filler as opposed to using originally edible meat. The FDA says pink slime is safe, but even if you believe that, why would anyone want to feed this to your children. Don’t get me wrong, enjoy a hamburger, but do it right and make sure the meat is actually real and do it yourself for the best results. The video below is really a must see for those who want to be educated more about this issue.
The reason the above is important is because I have recently become revolted by the revelation that most ground beef products humans are eating (primarily from fast food restaurants) contain something known as “pink slime.” Pink slime (see above) is a nick name for a filler substance made from previously inedible cuts of beef that are made edible through a spinning separation process that involves treatment with water and ammonia. I used to add ammonia to a mop bucket and hot water when I mopped floors as a kid. It is not something that should ever be added to food. I used to think that I could trust the ingredients label on the package to know what was in my food, but as it turns out when pink slime is used, it is not listed and neither is the ammonia present. This is because the FDA does not view ammonia as an ingredient but part of a “process.” This makes no sense whatsoever because all cooking is a process and if a substance is being added to my food, especially if it is a chemical, I want to know about it. This is why I have dramatically changed my eating habits and that of my children after writing the blog entry called: Does Your Kids Cereal Contain BHT or BHA? – Mine Did.
Fortunately, many fast food chains now say that they are pulling “pink slime” from their food products. Unfortunately, many school cafeterias are still serving it to children and they use it as a filler as opposed to using originally edible meat. The FDA says pink slime is safe, but even if you believe that, why would anyone want to feed this to your children. Don’t get me wrong, enjoy a hamburger, but do it right and make sure the meat is actually real and do it yourself for the best results. The video below is really a must see for those who want to be educated more about this issue.
Thursday, March 08, 2012
Why I Don't Go to the Doctor on My Birthday
Today is my birthday and I am NOT going to the doctor. You may be wondering why I am mentioning this, but there are a subset of people who go to the doctor on their birthday, despite the fact that most people try to avoid doing so. This applies not only to regular doctor visits but also to surgeries – most people try to avoid doing this on their birthday. Dr. Stuart Handysides (terrific name by the way) decided to study why some people decide to go to the doctor on their birthday and published his findings last year in the British Journal of General Practice (full reference below). He looked back at his files for 10 years (2001 to 2010) to identify such individuals and tabulate the reasons.
Dr. Handysides identified 30 people who did this, ranging in age from 1-90 (16 males, 14 females), with a modal age of 50 to 59 years. As it turns out, most of the people (10 of the 30) went in for an acute medical problem. As the author points out, if you have an acute medical problem you usually seek help when you need it, regardless of the day. However, such patients often express disappointment that their birthday has been taken up by a medical appointment. That being said, not every person seeks medical care the same day of acute symptom onset so Dr. Handysides speculated that a presentation to a doctor on a birthday signifies a more serious problem. Alternatively, he suggested that it may reflect a desire for reassurance that everything is ok on their special day. Another possibility, however, is that some people don’t care too much about their birthday and may not care about going to the doctor on a birthday.
It is interesting to note that in the study, that birthday consulters visited their general practitioner about 6.5 times a year which is almost double the normal average. Three people died on the year they consulted on their birthday, one of whom was the only patient in the study who consulted on two birthdays. The death rate of the birthday consulters was twice as high as non-birthday consulters. Interesting stuff and it may all be coincidence but I am happy that on my birthday, I am not going to the doctor. Special thanks to Dr. Handysides for sending me a copy of his article.
Reference: Br J Gen Pract. 2011 Sep;61(590):575-6.Characteristics of patients who consult their GP on their birthdays. Handysides S.
Dr. Handysides identified 30 people who did this, ranging in age from 1-90 (16 males, 14 females), with a modal age of 50 to 59 years. As it turns out, most of the people (10 of the 30) went in for an acute medical problem. As the author points out, if you have an acute medical problem you usually seek help when you need it, regardless of the day. However, such patients often express disappointment that their birthday has been taken up by a medical appointment. That being said, not every person seeks medical care the same day of acute symptom onset so Dr. Handysides speculated that a presentation to a doctor on a birthday signifies a more serious problem. Alternatively, he suggested that it may reflect a desire for reassurance that everything is ok on their special day. Another possibility, however, is that some people don’t care too much about their birthday and may not care about going to the doctor on a birthday.
It is interesting to note that in the study, that birthday consulters visited their general practitioner about 6.5 times a year which is almost double the normal average. Three people died on the year they consulted on their birthday, one of whom was the only patient in the study who consulted on two birthdays. The death rate of the birthday consulters was twice as high as non-birthday consulters. Interesting stuff and it may all be coincidence but I am happy that on my birthday, I am not going to the doctor. Special thanks to Dr. Handysides for sending me a copy of his article.
Reference: Br J Gen Pract. 2011 Sep;61(590):575-6.Characteristics of patients who consult their GP on their birthdays. Handysides S.
Wednesday, March 07, 2012
Move over Lite Brite...Child Swallows 37 Buckyballs
I remember when I was younger and I accidentally swallowed a Lite Brite peg, which was a small peg-shaped piece made of hard plastic. Fortunately, it was only one and there were no serious problems or complications that resulted. No one really uses Lite Brite anymore unless you have one of these relics in your attic. Instead, kids these days play with virtual Lite Brite, one of the iPad app. None of those kids will swallow any plastic pegs. But instead of Lite Brite pegs, parents now have something new to be careful about --Buckyballs.
If you have not heard of Buckyballs (or Buckeycubes), they are high powered colored magnets (pictured above) that can be connected to make all sorts of artistic designs and objects. Although they are not children’s toys, their color and shape makes them look appealing and fun to play with for children. Children have been known to put these objects in their mouth, perhaps because they look like some types of colored candies. Older children put them in their mouth to simulate a tongue piercing. Overall, 22 children are reported by the Consumer Product Safety Commission to have ingested small magnets.
In Oregon, a 3-year-old girl recently swallowed 37 Buckyballs, which then connected together in the child’s intestines. Because the magnets were so strong, when they connected they tore three holes in her intestines and one in the stomach. This required surgery to remove the Buckyballs and fix the tears. She is fortunately expected to make a full recovery. Signs and symptoms of magnet ingestion includes pain, nausea, vomiting and diarrhea. Of the 22 children who ingested magnets, 11 needed surgery. Don’t let the next one be your child. Keep these small objects away from the little ones if you have them.
If you have not heard of Buckyballs (or Buckeycubes), they are high powered colored magnets (pictured above) that can be connected to make all sorts of artistic designs and objects. Although they are not children’s toys, their color and shape makes them look appealing and fun to play with for children. Children have been known to put these objects in their mouth, perhaps because they look like some types of colored candies. Older children put them in their mouth to simulate a tongue piercing. Overall, 22 children are reported by the Consumer Product Safety Commission to have ingested small magnets.
In Oregon, a 3-year-old girl recently swallowed 37 Buckyballs, which then connected together in the child’s intestines. Because the magnets were so strong, when they connected they tore three holes in her intestines and one in the stomach. This required surgery to remove the Buckyballs and fix the tears. She is fortunately expected to make a full recovery. Signs and symptoms of magnet ingestion includes pain, nausea, vomiting and diarrhea. Of the 22 children who ingested magnets, 11 needed surgery. Don’t let the next one be your child. Keep these small objects away from the little ones if you have them.
Tuesday, March 06, 2012
My First Book Available for Pre-Order on Amazon.com
I am happy to announce that my first book (Mild Traumatic Brain Injury: Symptom Validity Assessment and Malingering) is now available here for pre-order at Amazon.com and will be released on 7/1/12. The entry lists a brief description of the book, which was co-edited by my colleague, Dr. Shane Bush. Amazon does not yet list the Table of Contents, but a sneak preview is presented below. A final version of the cover should be ready soon, with the picture to the top left showing a prior version.
Preface
1. Introduction: Historical Perspectives on Mild Traumatic Brain Injury, Symptom Validity Assessment, and Malingering
2. The Role of Clinical Judgment in Symptom Validity Assessment
3. Ethical Considerations in Mild Traumatic Brain Injury Cases and Symptom Validity Assessment
4. Differential Diagnosis of Malingering
5. Noncredible Explanations of Noncredible Performance on Symptom Validity Tests
6. Providing Feedback on Symptom Validity, Mental Health, and Treatment in Mild Traumatic Brain Injury
7. Research and Symptom Validity Assessment in Mild Traumatic Brain Injury Cases
8. Free-standing Cognitive Symptom Validity Tests: Use and Selection in Mild Traumatic Brain Injury
9. Use of Embedded Cognitive Symptom Validity Measures in Mild Traumatic Brain Injury Cases
10. Psychological Assessment of Symptom Magnification in Mild Traumatic Brain Injury Cases
11. Strategies for Non-neuropsychology Clinicians to Detect Non-Credible Presentations after Mild Traumatic Brain Injury
12. Assessing Non-credible Attention, Processing Speed, Language and Visuospatial/Perceptual Function in Mild Traumatic Brain Injury Cases
13. Assessing Non-credible Sensory-motor Function, Executive Function, and Test Batteries in Mild Traumatic Brain Injury Cases
14. Functional Neuroanatomical Bases of Deceptive Behavior and Malingering
15. Cognitive Performance Validity Assessment in Mild Traumatic Brain Injury, Physical Pain, and Posttraumatic Stress
16. Symptom Validity Assessment of Mild Traumatic Brain Injury Cases in Disability and Civil Litigation Contexts
17. Symptom Validity Assessment and Sports Concussion
18. Symptom Validity Assessment of Military and Veteran Populations Following Mild Traumatic Brain Injury
19. Symptom Validity Assessment with Special Populations
Preface
1. Introduction: Historical Perspectives on Mild Traumatic Brain Injury, Symptom Validity Assessment, and Malingering
2. The Role of Clinical Judgment in Symptom Validity Assessment
3. Ethical Considerations in Mild Traumatic Brain Injury Cases and Symptom Validity Assessment
4. Differential Diagnosis of Malingering
5. Noncredible Explanations of Noncredible Performance on Symptom Validity Tests
6. Providing Feedback on Symptom Validity, Mental Health, and Treatment in Mild Traumatic Brain Injury
7. Research and Symptom Validity Assessment in Mild Traumatic Brain Injury Cases
8. Free-standing Cognitive Symptom Validity Tests: Use and Selection in Mild Traumatic Brain Injury
9. Use of Embedded Cognitive Symptom Validity Measures in Mild Traumatic Brain Injury Cases
10. Psychological Assessment of Symptom Magnification in Mild Traumatic Brain Injury Cases
11. Strategies for Non-neuropsychology Clinicians to Detect Non-Credible Presentations after Mild Traumatic Brain Injury
12. Assessing Non-credible Attention, Processing Speed, Language and Visuospatial/Perceptual Function in Mild Traumatic Brain Injury Cases
13. Assessing Non-credible Sensory-motor Function, Executive Function, and Test Batteries in Mild Traumatic Brain Injury Cases
14. Functional Neuroanatomical Bases of Deceptive Behavior and Malingering
15. Cognitive Performance Validity Assessment in Mild Traumatic Brain Injury, Physical Pain, and Posttraumatic Stress
16. Symptom Validity Assessment of Mild Traumatic Brain Injury Cases in Disability and Civil Litigation Contexts
17. Symptom Validity Assessment and Sports Concussion
18. Symptom Validity Assessment of Military and Veteran Populations Following Mild Traumatic Brain Injury
19. Symptom Validity Assessment with Special Populations
Sunday, March 04, 2012
Walt Disney World and the Obesity Controversy
I have always loved Walt Disney World ever since I was a little kid. I recently went back for a trip with my family. I am not sure if I am just old enough to realize something I missed when I was a kid but as an adult it is easy to see that the Disney Corporation is trying to take on social causes that they believe will appeal to the majority of their customer base, even if the message is contradictory. For example, on a rainy day, my family and I were stuck in Epcot’s The Land exhibit and to pass some time, we watched a movie called Circle of Life: An Environmental Fable -- obviously designed for those who are passionate about the environment. In the film, the cartoon characters lament how terrible mankind is for knocking down trees and entire forests for development, which would include business expansion. At this point, I could not help thinking, “How do you think Walt Disney World was built?!”
More recently, Walt Disney World found themselves under attack from The National Association to Advance Fat Acceptance for allegedly being insensitive in another cartoon by reinforcing stereotypes that obese people eat junk food and watch TV too much television. Regardless of the merits of that argument, I object to Disney’s argument on other grounds. The fact is, people do not become obese from eating junk food or watching too much TV. You can become obese from eating excessive amounts of any type of food, regardless of whether it is junky or not. Also, you can watch all of the TV you want, but watching TV does not cause obesity. If Disney wants to promote any type of message about obesity, it should simply be this: if you take in more calories than you burn, you gain weight. Not too hard to understand. Even Dumbo can understand that. If you want to add something to it, you can say that eating too much, often combined with too much inactivity can cause obesity. People should not feel vilified for eating candy bars, drinking soda, or being a coach potato once in awhile. It’s all a matter of balance and doing things in moderation.
More recently, Walt Disney World found themselves under attack from The National Association to Advance Fat Acceptance for allegedly being insensitive in another cartoon by reinforcing stereotypes that obese people eat junk food and watch TV too much television. Regardless of the merits of that argument, I object to Disney’s argument on other grounds. The fact is, people do not become obese from eating junk food or watching too much TV. You can become obese from eating excessive amounts of any type of food, regardless of whether it is junky or not. Also, you can watch all of the TV you want, but watching TV does not cause obesity. If Disney wants to promote any type of message about obesity, it should simply be this: if you take in more calories than you burn, you gain weight. Not too hard to understand. Even Dumbo can understand that. If you want to add something to it, you can say that eating too much, often combined with too much inactivity can cause obesity. People should not feel vilified for eating candy bars, drinking soda, or being a coach potato once in awhile. It’s all a matter of balance and doing things in moderation.
Friday, March 02, 2012
My Medical Remake of Dr. Seuss's ABC Book
Theodor Seuss Geisel (affectionately known as Dr. Seuss) was born today in 1904. His books have delighted children and parents for generations, include my own. Thus, I pay tribute to Dr. Seuss with a medical version of his famous ABC book. I hope you enjoy it. If so, please share with others.
Big A
little a
What begins with A?
Aunt Aunnie’s angiography.
A..a..A
Big B
little b
What begins with b?
Basophil
baby
bone scan
and a
biopsy.
Big C
little c
What begins with C?
Cancer on the colon
C..c..C
Big D
little d
Dr. Dominic Doo
dreamed
a dozen discharges
and
a dentist too.
ABCDE..e..e
e. coli
edema
eosinophil
e
e
E
Big F
little f
F..f..F
Four fetid feces
on a
Fiber-feffer-feff
ABCD
EFG
Gram
Girl
Gynecologist
G…g…G
Big H
little h
Headache head
HEY!
Halloween is here
Hooray! Hooray!
Big I
little i
i..i..i
Intestines
are
irritable.
So am I.
Big J
littlej
What begins with j?
Jimmy Jolly’s
jaundice
and janiceps
begin that way
Big K
little k
kilogram-aroo
Kick a Kaposi's
sarcoma
and
Korsakoff’s too.
Big L
little l
Little Liter Lopp
Left loin.
Lower neuron
lacrimal drops.
Big M
little m
Many MRIs
are making
multiple sclerosis
and the myelin
mighty bright
Big N
little n
What begins with those?
nine neuropsychologists
and a neutrophil
and a nose.
O is very useful
You use it when you say
“Ophelia’s ophthalmologist
owns
an orange optometer today.”
ABCDEFGHIJKLMNO…P
Pregnant Preeclampsia
Plasma in a pail
Peter’s poisoned poulty
And now
Protein’s in the pail.
Big Q
Little q
What begins with Q?
The quad
Queen of Quadriceps
and her
quadriplegia too.
Big R
Little r
Rosy Rehab Ridth
Rosy’s going running
With a low red cell distribution width.
Big S
Little s
Silly Shelley Smith
Saw a squamous lesion
And got
sick sick sick.
T…..T
t…..t
What begins with T?
Ten tired tapeworms
On the trunk of a tree.
Big U
little u
What begins with u?
Unmyelinated axons
and an
ultrasound too.
Big V
little v
Vera Vermis Vinn
is
very
very
very awful
taking vitamins.
W..w..W
wrinkle Wally Woo
washes Wendell Wiggins
who’s on the
Wall of Fame too.
The X chromosome is useful
if you want
to be a girl
X-rays comes in handy
All throughout the world.
Big Y
little y
Young yellow skin.
Yvonne did yoga
With the yang
But not the yin.
ABCDEFGHIJKLMNOPQRSTUVWXY..and…
Z
Big Z
little z
What begins with Z?
I do.
I'm a
Zinc Zafirlukast
as you can
plainly see.
Wednesday, February 29, 2012
A Follow-Up to The Psychological Profile of TJ Lane
Yesterday,
I posted a psychological profile of Chardon school shooter, T.J. Lane (pictured to the left). As always happens, the day
after such incidents, more detailed information emerges about the shooter. So
far, everything I have read confirms the information I posted yesterday. Lane
has already confessed to prosecutors that he shot his victims at random and did
not know them (although he apparently knew one in middle school).
This is consistent with the pattern of many school shooters, and the theory that he was lashing out against a “system,” be it society, government, the educational system, or all three. This type of behavior actually transcends school shooters and fits into a broader category of mass murderers who commit terrorist acts. For example, I remember walking through the Oklahoma City Memorial and seeing the tiny shoes of the babies who lost their lives after Timothy McVeigh bombed the federal building. McVeigh did not view the babies as innocent individuals who he had a personal problem with but saw them as necessary casualties of war in his fight against the government. In this sense, the victims are actually symbolic representations of a much larger system that the aggressor is upset about.
This is consistent with the pattern of many school shooters, and the theory that he was lashing out against a “system,” be it society, government, the educational system, or all three. This type of behavior actually transcends school shooters and fits into a broader category of mass murderers who commit terrorist acts. For example, I remember walking through the Oklahoma City Memorial and seeing the tiny shoes of the babies who lost their lives after Timothy McVeigh bombed the federal building. McVeigh did not view the babies as innocent individuals who he had a personal problem with but saw them as necessary casualties of war in his fight against the government. In this sense, the victims are actually symbolic representations of a much larger system that the aggressor is upset about.
Although
violence prediction is difficult, for Lane’s lawyer to say that this could
never have been predicted is simply not true. Lane clearly was in a high risk
category for this type of behavior based on what was noted yesterday. Part of
this high risk comes from a troubled family life. More specifics regarding this
have emerged that fits yesterday’s profile. Specifically, Lane's father has been arrested several times for violent
crimes against female acquaintances, including his mother. For the first two
years of Lane's life, his parents (who divorced in 2002) were both arrested for
domestic violence against each other. His father also served prison time for
assaulting a police officer and was charged with holding another woman under
running water and bashing her head into a wall. He has been charged with
kidnapping, felonious assault, attempted murder (eventually dropped), and
disrupting public service. His father had been warned by law enforcement officials
to stay away from him on multiple occasions. Thus, Lane clearly had a role
model in life for violent behavior as a means to solve problems and lacked proper
parental role models.
It was noted yesterday that Lane
attended an alternative H.S. and that this made it likely that he had academic
and behavioral problems. Information disclosed today revealed that his
alternative H.S. was a place for "at risk" students who are
"reluctant learners" with problems such as "substance abuse
/chemical dependency, anger issues, mental health issues, truancy, delinquency,
difficulties with attention/organization, and academic deficiencies."
Thus, there clearly were concerns that people had about him but it is unclear yet
if any mental health professionals evaluated him and if anyone made any
connections between his family background, belief systems, and tendencies for
aggressive behavior.
On the 911 tape, Lane was described as a quiet kid who did
not really talk to anyone, which, according to one friend, was associated with
a Goth phase he became involved in as a freshman. Neighbors described him as
very sullen, rarely showing his face and always wearing a hoodie, the latter
being yet another symbol of alienation from society (when interpreted in the
context of everything else that is known about him) as the hood can serve as a shell
for him to hide in. It is noted that he wore a gray hoodie (again note the
absence of bright colors) on the day of the school shooting based on 911
witness accounts. Another student noted that he would sit in the lunch room and
no one knew he was there. That is interesting considering that the shooting occurred
in the lunchroom. The school lunchroom is one of the most stigmatizing
locations in school because this is where the student body becomes segregated
into cliques. Students sitting by themselves in the lunch room (either by
choice or through not being accepted) can be another sign of social alienation.
Thus, he may have chosen an area that symbolized his social alienation as an
area for the school shooting. The large availability of students to chose from
in the lunchroom setting may have also played a roll.
Suggested Reading: Without Conscience: The Disturbing World of the Psychopaths Among Us
Suggested Reading: Without Conscience: The Disturbing World of the Psychopaths Among Us
Tuesday, February 28, 2012
A Psychological Profile of Chardon School Shooter, TJ Lane
Nowadays, it seems like a school year does not pass by
without a school shooting and the death of innocent children. When I was
younger, the most other kids had to worry about was the school bully or maybe a
gang, but no one ever feared that they could get killed in their classroom. It
is difficult to say why school shootings have become so common these days.
It is likely some combination of increased access to firearms, worsening forms of bullying (such as cyberbullying), the influence of violent revenge themes in the media and entertainment venues (e.g, music, movies, video games), the breakdown of the family structure, and the increased availability of subculture movements such as Gothic and Emo that foster a sense of alienation from mainstream society. None of these factors by themselves is likely to trigger a school shooting. For example, there are many Gothic children and people who play violent video games who do not commit school shootings but the more of these variables are present, I believe that the likelihood of a school shooting increases.
It is likely some combination of increased access to firearms, worsening forms of bullying (such as cyberbullying), the influence of violent revenge themes in the media and entertainment venues (e.g, music, movies, video games), the breakdown of the family structure, and the increased availability of subculture movements such as Gothic and Emo that foster a sense of alienation from mainstream society. None of these factors by themselves is likely to trigger a school shooting. For example, there are many Gothic children and people who play violent video games who do not commit school shootings but the more of these variables are present, I believe that the likelihood of a school shooting increases.
Like many people, I am always interested in learning more
about the shooter and the specific motive(s) behind the attacks. Before I know
anything about the individual, however, there are a few things that I can
usually make some safe assumptions about: 1) The person feels angry with and
alienated from his peers and society (especially when the shooters attack
people at random), 2) There were traumatic events (e.g., bullying, abuse,
significant family dysfunction) in the person’s past that led to these feelings
(which is not to excuse the shootings of course), 3) There is usually something
in the person’s appearance (e.g, style of dress, physical characteristics) that
shows that they are different in some way from their peers, 4) The person
usually sends some signal ahead of time that the shooting was to occur. As it
turns out, it seems that all of these criteria appear to have been met in this case. The reader should know that I have never met T.J. Lane and that I am not a professional criminal profiler. The profile of Lane that I put together is based on what I could gather from his Facebook page, early media reports (some of which may later be modified), knowledge of clinical psychology, and common sense.
When I first saw the picture above of the shooter, TJ Lane, my first reaction
was that it fit the psychological profile I have of these shooters. The picture
comes from his Facebook profile. Of all the pictures, he could choose, he
picked one that was black and white, thus devoid of color. Color symbolizes
positive emotions whereas black and white symbolizes the absence of such
emotions and conveys a sense of despair and alienation, especially when other
themes associated with this are present. This dark theme goes along with his
black jacket, which may be related to the Gothic culture he became involved in.
Note how he is looking to the side and not to his audience (Facebook friends). In
this picture, he is showing that he does not want to look at you or have to
look at you because he does not feel connected with you. The side profile picture
also bears resemblances to side profile mug shots. You will notice that he is
not smiling but instead looks disninterested, annoyed, and possibly angry. Self-esteem
is likely low, which accompanies feelings of insecurity. His hands are in his
pockets. Hands and fingers symbolize a sense of control (since we mostly
control our environment with our hands and fingers) and thus hands in the
pockets may indicate that he feels a loss of control in his life. Taking a gun
and shooting people is a maladapative way to re-exert control and gain
attention, which can improve his own feeling of self-importance. He is thin and
one is left to wonder if he was picked on for his appearance, which was later
confirmed via media reports. Other pictures on his Facebook page showed him
shirtless with his arms folded and a defiant look on his face and he is never
smiling. Thus, the only times where he does look at his audience, he is
conveying a sense of anger. The profile picture was updated last, however,
indicating a growing sense of alienation from others.
Initial media reports stated that Lane had family problems, was
being constantly teased by many of the kids in school (e.g., about his hair,
clothes, quiet demeanor), often had a sad look in his eyes, was upset about a
girl in school, was quiet, very guarded, and a loner who did not belong to any
particular group. Some students assumed
he was normal but admitted they did not know much about him. One student stated
he got into the Goth phase in the 8th grade. He lived with his
grandparents, his older brother was in prison, and he attended an alternative
school, which indicates he had a history of academic and/or social emotional
difficulties requiring alternative school placement. He may have had a split
with a girlfriend on Valentine’s Day and may have been upset that she was
dating a former friend. In fact, on 2/17/12, he posted a song on his Facebook
page entitled “Blood on the Dancefloor” that centered around an angry male figure
with a demonic Gothic appearance trying to break the spell of a female lover.
This included lyrics such as “Now is the time, now is the hour. To take back my
heart, to take back my power. This is the moment to break your spell. I see
right through you... Burn in hell witch.”
Review of Lane’s Facebook page showed that he claimed to
work for a non-profit organization called “Free the Slaves,” which claims to
liberate slaves around the world and attack the systems that allow slavery to
exist. Note the phrase “attack the systems” which generally refers to
governmental systems (which includes school). He could have taken this phrase
literally in carrying out an attack against “the system.” This may sound like
wild speculation, but consider the following. He clearly seems to have felt alienated
from the educational system as indicated by the fact that under “College” he
listed “We don’t need no education.”
Even more troubling was that under High School, he wrote “We don’t need
no thought control.” Thus, he seems to have believed that his school was
controlling his thoughts, all of which sounds eerily similar to the video of Jared Loughner walking through
Pima County College, ranting about mind control, loss of freedom of speech, the
school’s control of the grammar, and his “genocide school” before he shot,
injured, and killed several people at a governmental event.
The phrases “We don’t need no education” and “We don’t need
no thought control” come from the famous Pink Floyd Song, “Another Brick in the Wall” which partly has to do with a protest against rigid schooling. Incidentally,
Pink Floyd is listed as one of his favorite music groups. The music video for
the song portrays a teacher reprimanding a young student (who bears some
resemblance to Lane) for writing poems in class, which Lane liked to do (see
end of this blog entry). The child then engages in fantasies of destroying the
school and killing his teacher.
This begins to suggest the possibility of a psychotic
disorder in which one is detached from reality. This is again speculation, but
further suggestive of this was that he listed one of his favorite philosophers
as David Icke, who has described himself as being the most controversial
speaker in the world based on his belief that a secret group of reptilian
humanoids called the Babylonian Brotherhood is controlling the world. Icke’s
worldview is replete with conspiracy theories, which is common among people
with paranoid belief systems.
Lane also listed Credo Mutwa as a favorite philopher. Credo
Mutwa is a Zulu sangoma (spiritual healer) who is know for his writings against
the African government in his pursuit to see the “truth.” In Mutwa’s own words,
“I am one of the scums of this earth, a creature dejected and ridiculed by
university professors” and “I have been scorned; demonise lied about by
conspirators…” This is another reference to alienation and anger towards
educational systems. Interestingly, Credo Mutwa writes about listening to David
Icke. One of Lane’s favorite books listed was David Icke’s “Guide to the Global
Conspiracy and How to End It.”
Another book Lane listed as a favorite was “Alice in the Country of Hearts.” The book
centers on an insecure main character (who Lane likely identified with) in a
strange world named Wonderland and is forced to interact with the inhabitants.
Everyone in Wonderland is reckless as to who lives or dies, everyone distrusts
each other, and has an instinct to kill. Sound familiar? Continuing with Lane’s
seeming immersion into a bizarre fantasy life was that another favorite book
listed was the “Death Note” series, which centers around a high school student
who finds a book called the Death Note that allows the reader the ability to
kill anyone whose name and face they know by writing the name in the book and
picturing their face. To date, several students across the country have been
caught and disciplined for possessing Death Note books containing the names of
other students. I will not be surprised at all if Lane had one as well.
In terms of movies, Lane listed the movie “Let Me In,” which
tells the story of an adolescent boy who is continuously harassed by bullies,
neglected by his parents, and develops a relationship with a vampire child (re:
Gothic association). He also liked “Fight
Club,” which is a violent movie that was designed to serve as metaphor for the
conflict between the younger generation and the traditional values of society.
Lane’s sense of disconnection from society is emphasized by him writing that
one of his interests and activities is “wandering aimlessly.”
This story is clearly the writings of an angry and insecure individual who has strong revenge fantasies. The castle was likely a metaphor for his school and he was foreshadowing events to come. Unfortunately, as in many similar cases, no one put the pieces together before hand. In fact, four of his Facebook friends liked the story and 49 shared it with other friends. No one wrote a public comment of concern or disapproval. For a follow-up to this blog entry on TJ Lane, click here.
Suggested Reading: Without Conscience: The Disturbing World of the Psychopaths Among Us
Related blog entries:
A Psychological Profile of Wade Michael Page: The Sikh Shooter
A Psychological Profile of James Holmes: The Joker Killer
Cannibal Icepick Killer Luka Magnotta was Not Born Evil.
Monday, February 27, 2012
Restaurant Impossible Shines Light on the Need for Health Department Reform
A TV show I enjoy tuning into is Restaurant Impossible. To
those who may be unfamiliar with it, the show revolves around all-star chef,
Robert Irvine (pictured to the left), who goes to failing restaurants and tries to save them in two
days with a $10,000 budget. This often involves improving customer service,
redesigning menus, improving kitchen cleanliness, improving marketing, and/or redesigning
restaurant.
One of the patterns I have noticed on the show is that many
of these failing restaurants have filthy kitchens. But last week, I saw the
most extreme and appalling version of filth when I watched the episode called
“Anna Maria’s” in which Chef Irvine tried to fix a restaurant that bears this name
in Dumore, Pennsylvania. Among the problems noted during the show were a)
layers and layers of food and grease covering stove tops, pots, overhead vents,
and kitchen appliances (which included a pot on the stove that was caked in so
much black grime it looked like something you would find in a dungeon); b)
bacteria, slime, and old food on the floors, and behind/under/on restaurant equipment,
c) filthy refrigerators with open containers of food, and c) a basement with
food (e.g., flour) stored next to chemicals. Of all the shows, I never saw Chef
Irvine so upset. He nearly vomited in the kitchen on screen and suggested that
he actually did vomit later in the show. I could go on describing the horrors
of this kitchen but you really have to see the show to believe it.
The advertisement for the show on my DVR said that the kitchen
had not been cleaned in about 25 years. I am not sure if that was hyperbole,
but regardless, the kitchen clearly had not been cleaned in a long time. When I
heard this and saw the state of the kitchen, I was shocked and upset that the
government could allow a restaurant to continue to serve food to the public
like this and put them at risk of food poisoning (e. coli). But I was even more shocked when I read an article
stating that the restaurant actually passed a health inspection nine months
prior. The restaurant owner’s son claims that the Food Network exaggerated the
state of the restaurant for the purposed of TV.
While I am fully aware the not everything on TV is how it
seems, it simply stretches all credulity for me to believe that the Food
Network planted the dirty pots, coated the kitchen equipment with
bacteria-laden slime, made the refrigerators filthy, planted old food behind
equipment, and brought food in the basement to put it next to chemicals. There
is too much evidence the other way, such as that a) the chef (Rudy) said on
camera that the kitchen had been in that condition for four years, b) the owner
and her son allowed Irvine to send customers home after he tossed out a filthy
stove vent for them to see, c) the owner and son admitted that the kitchen had
fallen into an embarrassing state, d) the show normally does not spend this
much time focused on kitchen clean-up needs, e) no one has sued the Food
Network over false presentation, f) Chef Irvine genuinely appears to want to
help people, and g) the visual evidence of the state of kitchen clearly
indicates this was a process that took a very long time to create.
It is all too easy to blame the Food Network for
exaggerating the state of restaurant as part of some type of conspiracy theory.
How about two alternative and more parsimonious explanations: 1) The restaurant
owners are embarrassed and understandably concerned that no one is going to
come to their new restaurant after seeing an expose of it on television (which
is a public relations disaster) and so they blame the Food Network for
exaggerating it as a form of damage control; 2) The Health Department is not
doing their job.
Explanation number one does not need a further explanation,
but consider number two a bit further. Not only did this restaurant pass health
explanation nine months prior, but not a single violation or risk factor was
found. How can that possibly be true? It is possible that the inspection was
either never done but signed off on or that an inspector signed off on the
report knowing there was a deficiency. Why would that be? Sometimes, restaurant
owners have political connections with health inspectors that allows the
process to be circumvented. This is more likely to be the case in small cities
such as the one this show was filmed in.
All in all, I now have no confidence that health inspections
mean anything and have become increasingly careful about the types of
restaurants I frequent, preferring to go to ones with an open kitchen that I
can see for myself or ones where I can peak into the kitchen. If I cannot see
the kitchen, then I use proxy indicators such as how clean the bathrooms are,
floors, tables, walls, ceilings, the dining ware, the staff, and the food as an
indicator of the state of the kitchen. State, county, and city governments need
to revisit the health inspection process to make reforms so that the process works as
intended and the public can once again have confidence in how the system
works. I also believe there should be a law that allows customers to view the
kitchen of restaurants before placing an order.
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