Saturday, April 21, 2012

Providing Independence and Safety

As family members grow older, the risk of being alone increases. If you have a loved one who is living by himself at home, a medical alert system might be his only way to communicate in an emergency. These lifelines are a must for any senior who desires to remain independent without sacrificing his safety.

Moving into an assisted living center signals the end of independence for a senior, which can be emotionally devastating. If a senior can still take care of herself and conduct daily activities without help, there is no need for her to move. Remaining in her own home can prevent the trauma of losing her independence. Medical alert devices are used to let the senior stay in her home, which may make improve her happiness level by staying independent.

A medical alert device gives even the most independent senior citizens a safety net. Should the senior fall and cannot reach a phone, she only has to touch the button on the medical alert device she wears to send a signal to the the system's dispatcher who may contact the family, an ambulance, or a doctor. This method is the preferred option as the dispatch center acts as a control to determine the level of assistance the senior needs. Sometimes the signal goes straight to the local 911 dispatcher, but such 911-direct systems pose the risk of triggering too many false alarms with 911.

Most alert systems are designed for simple use, even for a senior who may have difficulty with moving their hands or seeing. Such simplicity makes these devices a better alternative to a home telephone or cell phone in an emergency because phones require remembering and dialing several numbers. A senior in an emergency situation may not recall the phone number of those she needs to reach. With a pendent alert, a single button gets the senior in touch with a person who will get help.

While there are a variety of medical alert systems available to choose from, the important thing is to find one for your senior loved one. Giving them an alert device can give you peace of mind knowing that your relative will be able to get help in an emergency. Such a device also gives the senior the ability to remain independent while maintaining her personal safety. There can be no better gift for every member of the family.

The above is a guest blog entry.

Friday, March 30, 2012

Ladies...Check Those Tampons

A few days ago, a blogger named Danielle Parr posted the image below, stating that she discovered it in a box of Kotex tampons. She stated that it was a moldy tampon, and yes, that’s exactly what it looks like. Usually, we associate mold with old food, bathroom walls, attics, toilet or toilet bowls but it can infest cotton or rayon, the materials used to make tampons. Many women who use tampons have gotten into such a routine with them, that it is common to just take them out of the wrapping and insert them without looking at them. Based on this story, it makes sense to check these things out before using them. If anyone inserted a moldy tampon inside of them, you could potentially become quite ill, despite Kotex officially responding that the mold poses no health risk. As of now, the mold is being testing by ABC affiliate, WFAA. Lastly, it is worth noting that people have claimed finding all sorts of things in manufactured products, only for it to later be found to be a false claim. However, Kotex’s response that this sort of mold has been found on their tampons before makes that unlikely to be the case here. The difference is that now people have blogs and can get information out to the masses.

Thursday, March 29, 2012

Why Obamacare is in Deep Trouble

In the 2007 Democratic primary, Barack Obama and Hillary Clinton fought tooth and nail on many issues. One of them was on universal healthcare, in which every American would have health insurance. Both agreed that they wanted to implement a universal healthcare system but they differed on the approach. Hillary’s plan was to implement an individual mandate. That is, each American would be forced to purchase healthcare or face a stuff penalty. Obama opposed the mandate at the time because he stated Americans who could not afford to purchase it would be worse off – they would have no health insurance, plus they would have to pay a fine or have the money taken out of their pay checks. He compared this to forcing the homeless to buy houses, obviously something that would be ridiculous.

Once Obama was elected, however, his healthcare plan changed in that he implemented the exact individual mandate that he railed against during the campaign. That is, if you did not purchase health insurance you could not only face a fine but be imprisoned. Obama defended this by arguing that if his plan lowered the cost of healthcare premiums by having more people pay premiums, that it would not be fair to allow some people not to pay for it. He also argued that this is similar to people being mandated to purchase car insurance. However, there are two major differences. The first is that auto insurance laws are set by the states and states do have a right to set mandates. The difference with a federal health insurance program, however, is that while the U.S. Constitution grants the federal government (via Congress) the right to regulate commerce, it does not grant it the right to force people to purchase anything such as insurance premiums. Secondly, even in states where there are mandates to purchase auto insurance, this only applies if you own an automobile. But there is no mandate to purchase the automobile to begin with and not everyone owns an automobile for various reasons. 

The other problem with a federal healthcare mandate is that it opens the door to almost any activity that can be conceivable linked with healthcare to be federally regulated such as the types of food you eat (e.g, a mandate to eat vegetables every day) and the activities you engage in (e.g., mandated exercise). For a country that was established on the principles of a centralized government with limited federal powers, the individual mandate would open new doors to increase those powers dramatically. In addition, the mandate would essentially amount to a tax on young people to pay thousands of dollars in healthcare premiums (when the true cost they should be paying is under $1000) to help pay for the costs of the elderly and the sick. Thus, the mandate is essentially a tax that is not explicitly identified as one. It’s a hidden tax and no one likes hidden taxes. However, most Americans have figured this one out and most people want the law repealed.

What is really incredible about this whole issue is that the Obama administration and many other Democrats apparently never considered that an individual mandate could be considered unconstitutional. Either that, or they did think about it but did not believe it would be successfully challenged. For example, when House Speaker Nancy Pelosi was asked about this very issue two years ago by a reporter, her only response was repeating the phrase “Are you serious?”

Now, the individual mandate and the healthcare law is before the U.S Supreme Court since 26 states have challenged it along with a group of plaintiffs consisting of the National Federation of Independent Business. If the questioning by the Supreme Court Justices is any hint as to the final ruling (which is usually the case) then it looks like the individual mandate will be ruled unconstitutional. If that occurs, Obamacare (Patient Protection and Affordable Care Act) may be eliminated entirely because the mandate is critical for the law’s success.

Wednesday, March 28, 2012

10 Conditions Parents Often Misdiagnose

The article below was sent to me by the staff at the National Nannies website and per their request, I have decided to feature part of it here because I thought that some of the points are well-made.

One of the roles we play as parents on occasion is that of family physician. Recognizing and treating minor ailments and then deciding whether a doctor visit might be in order is all in a day’s work for most moms and dads. That’s not to say our diagnoses are always right; we do get it wrong on occasion too, and here are some common illnesses and ailments that trip us up. The following is a list of the 10 most misdiagnosed kids’ ailments by parents:
  1. ADHD – Parents will often interpret the signs of this disease as being indicative of a disruptive or unruly child. It is necessary to conduct testing to ascertain that the child is indeed suffering from Attention Deficit Hyperactivity Disorder.
  2. Asperger’s Syndrome – Parents of children with Asperger’s Syndrome will frequently confuse the symptoms with autism. Naturally, either case requires a professional diagnosis, but initial tendency is for parents to lean towards their child having autism unless proven otherwise.
  3. Bacterial Meningitis – Sharing many of the same symptoms of the flu such as fever and headaches, bacterial meningitis is often mistaken for the more common flu. Light sensitivity, seizures and skin rashes may also accompany those symptoms.
  4. Vocal Cord Dysfunction (VCD) –This illness is characterized by sudden, abnormal narrowing of the vocal cords, which results in obstructed airflow and a wheezing sound during breathing. This is frequently misdiagnosed by parents and doctors alike as asthma.
For more, see the original version is at this link.

Tuesday, March 27, 2012

The Mickey Mouse Sign in Medicine: part 4

Today is the fourth and last example of the Mickey Mouse sign in the field of medicine. The image below comes from a 63-year-old man with diabetes mellitus who underwent ultrasound scanning of the femoral arteries (types of arteries in the legs). The picture below (presented in this article) shows a Mickey Mouse appearance formed by the presence of a blood clot in the legs.  Such blood clots are not always associated with symptoms and can be deadly. The presence of the Mickey Mouse sign on such scans helps identify such blood clots much easier. Be sure to check out the first, second, and third examples of the Mickey Mouse sign. The image below is copyrighted by BMJ Publishing Group Ltd & the British Association for Accident and Emergency Medicine.

Monday, March 26, 2012

The Mickey Mouse Sign in Medicine: part 3

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

Tuesday, March 06, 2012

My First Book Available for Pre-Order on

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 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.


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.

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.

Big B
little b
What begins with b?
bone scan
and a

Big C
little c
What begins with C?
Cancer on the colon

Big D
little d
Dr. Dominic Doo
a dozen discharges
a dentist too.

e. coli

Big F
little f
Four fetid feces
on a


Big H
little h
Headache head
Halloween is here
Hooray! Hooray!

Big I
little i
So am I.

Big J
What begins with j?
Jimmy Jolly’s
and janiceps
begin that way

Big K
little k
Kick a Kaposi's
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
an orange optometer today.”


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.

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
very awful
taking vitamins.

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.

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.

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

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.

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.”

Lane’s Facebook page also contained dark poetry that he wrote in class and posted on 12/30/11: "In a quaint lonely town, sits a man with a frown. No job. No family. No crown. His luck had run out. Lost and alone. His thoughts would solely consist of “why do we exist?” His only company to confide in was the vermin in the street. He longed for only one thing, the world to bow at his feet. They too should feel his secret fear. The dismal drear. His pain had made him sincere. He was better than the rest, all those ones he detests, within their castles, so vain. Selfish and conceited.” He goes to discuss how the castle kept the peasants at bay and did not keep the enemies away and how he castle’s every story “was just another chamber in Lucifer’s laboratory.” The story continued to attack society and desires for the castle to fall. He wrote about going through the castle, past guards, and making others beg for mercy and ending with "Feel death, not just mocking you. Not just stalking you but inside of you. Wriggle and writhe. Feel smaller beneath my might. Seizure in the Pestilence that is my scythe. Die, all of you."

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.

Friday, February 24, 2012

Cookie Monster Is Not Autistic

In 1984, an article was written in the publication, Children Today, in which Cookie Monster was labelled by children with disabilities as autistic because he ate messy and only said "Cookie." Scientific understanding of this condition has greatly improved since then and at this point, I do not believe Cookie Monster would meet diagnostic criteria for autistic disorder (also known as autism).

RECOMMENDED BOOK: Autism: A Practical Guide for Parents

One of the essential criteria for autistic disorder is that the affected individual has a qualitative impairment in social interaction. This can be manifested by at least two of the following: a) marked impairment in nonverbal behaviors to regulate social interaction, b) failure to develop peer relationships appropriate to developmental level, c) lack of spontaneous seeking to share enjoyment, interests, or achievements with people (e.g., by pointing out objects of interest), or d) lack of social or emotional reciprocity.

Cookie Monster clearly demonstrates adequate social interaction. For example, in the interaction below with Kermit The Frog, he uses very good eye contact and hand gestures to facilitate communication. He clearly demonstrates social reciprocity in playing the guessing game with Kermit and it is clearly established in Sesame Street that he has developed good relationships with other Muppets such as Kermit, The Count, and Prairie Dawn.

The next criteria that would need to be met is a qualitative impairment in communication. This would be evidenced by at least two of the following: a) delay or total lack of the development of spoken language, b) marked impairment in the ability to initiate or sustain a conversation with others, c) stereotyped and repetitive use of language or idiosyncratic language, or d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

While Cookie Monster does have some problems speaking with proper grammar (e.g., “Me Want Cookie!”) he does not truly meet any of the criteria mentioned above. Someone may want to make an argument that his language is idiosyncratic and that he can sometimes be repetitive (e.g., “Om, om, om, om, om”) when he eats a cookie, but I just chalk that up to him being extremely happy that he is eating cookies. Clearly, Cookie Monster is very capable of carrying on lengthy conversations, initiating them (as he does in the video clip with Kermit), and sustaining them.

Lastly, to meet criteria for autistic disorder, Cookie Monster would need to have a repetitive or stereotypes pattern of behavior, interests, and activities, as manifested by at least one of the following: a) an encompassing preoccupation with one of more stereotypes and restricted pattern of interest that is abnormal in intensity and focus, b) an apparently inflexible adherence to specific, nonfunctional routines or rituals, c) stereotyped and repetitive motor mannerisms, and d) persistent preoccupation with parts of objects.

Cookie Monster can be said to meet some of the latter criteria (a and b) because he is clearly pre-occupied with cookies to an abnormal degree and it seems that he has to eat his cookies each day and is not too flexible on the matter. However, anyone can meet one or two criteria of various mental health disorders without having the condition of interest due to not meeting full diagnostic criteria. That is the case with Cookie Monster. I have not seen any convincing evidence that he meets criteria c or d.

So what does our furry little blue friend have wrong with him? Obsessive compulsive disorder (OCD) is technically possible in which his compulsive cookie eating may be a way to relieve anxiety caused by recurrent and persistent thoughts to devour cookies. However, to answer this would really require a good clinical interview with him to see if he meets all the criteria of true obsessions and compulsions. Furthermore, he would need to engage in compulsive cookie eating for more than an hour a day and we do not know if he does that. Another possibility is bulimia nervosa, in which someone binge eats a large amount of food and then uses inappropriate mechanisms to prevent weight gain, such as vomiting or laxative use. We have no idea if Cookie Monster is running to the bathroom afterwards but if he is trying to prevent weight gain, it does not seem that it is working as he does seem overweight.

My impression is that Cookie Monster has impulse control disorder not otherwise specified.  This is a failure to resist an impulse, drive, or temptation to perform an act that is harmful (e.g., causing obesity, diabetes mellitus) to the individual or others. Most people with this condition feel an increasing sense of tension or arousal before committing the act and then experience pleasure, gratification, or relief at the time of committing the act.

Related Blog Entry: Why Kermit the Frog Rules.