Friday, January 1, 2010

The Age of American Unreason.

I finally picked up tonight, after possessing it for a year, purchased on recommendation from a friend, Susan Jacoby's The Age of American Unreason. Because I'm only beginning to grasp the supposition of the book - or rather, because I'm inclined to agree with my own limited understanding of the book's direction - I came across this bit of illogical and paranoid garbage, below, on a blog by Timothy Birdnow.

The quote, a few paragraphs of something much longer that you may have more patience with than I do, is a screed of silliness, a perfect bit of hyperbolic, irrational unreason:

Besides Atty. Gen. Holder’s working for a law firm that defended Guantanamo terrorists, the decision to hold the trial of the five Guantanamo terrorists in New York City was the inspiration of the terroristic attempt in the skies over Detroit.

Umar Farouk Abdul Mutallab could have gone into the airplane’s many bathrooms anywhere between Amsterdam and Detroit, but he wanted to near the end of the flight to be in a position to go on trial in Detroit if he failed, in a city in an area with the largest Muslim population concentration in America.

The plan was and is, in my opinion, planned to get Muslims on a civilian jury (Obama would not be turning him over to a military tribunal) and have a hung jury not convict Mutallab, thus further demoralizing Americans and making them feel they are impotent to stop a terrorist attack and the advancement of jihad.

Reports at Atlas Shrugs and other sources state that Muallab did not resist when attacked by the passengers and crew. That means the terrorist, once failing to ignite a bomb, was in a position to stand trial in a Detroit area courtroom. If he had fought, he might well be killed, as happened to the Westerner who attempted to violently open an airliner cabin door in a flight approaching Salt Lake City almost a year before 9/11 (no Federal charges were filed against the passengers).

The reasoning Birdnow throws out is hardly worth bringing up but it is typical of so much of the falsehoods and poor logic applied to the political and criminal actions taking place in the US right now - it is a situational explanation for a terrorist's act that irrationally requires that 1. The bomber expected to fail, 2. In doing so, he schemed to get tried in Detroit 3. Because Detroit has a lot of Muslims, he expected a hung jury 4. And believed that a hung jury would demoralize America (which of course is already demoralized because it is led by a black president who naturally, because of his color and middle name, is soft on terrorism.)

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Top 10 Geriatric Advancements of the Last Decade.

Dr. John Morley at (St. Louis) notes the big medical advancements in geriatrics:

While there is still a severe shortage of geriatricians, this has been a decade in which both the public and politicians have become more aware of the need for specialist physicians who focus on the care of older persons. Geriatricians tend to focus on the older person’s ability to function, rather than on specific disease processes. This tends to give them a different perspective on medical advances. Here are my top ten breakthroughs in geriatrics in the last decade:

1. Exercise and sarcopenia. This decade has dramatically increased the awareness of the need for regular exercise (at least three times a week) for older persons. It has become clear that resistance exercise is essential to allow older persons to maintain muscle mass and strength (Stop sarcopenia). Simple exercise has also been shown to prolong life e.g. regular stair climbing; decrease the chance of developing dementia and slowing functional decline and enhancing the mood in depressed people. In the case of persons who are falling, resistance exercise along with balance exercise decreases falls. Physical therapists are now aware that as older persons develop memory problems, they find it difficult to “walk and talk”. Special exercises have been developed to improve the person’s ability to do another task while walking. All older persons who are falling should have six weeks of home exercise therapy from a physical therapist. All persons should increase their Spontaneous Physical Fun (SPF) by parking far away from their destination and climbing stairs.

2.Recognition of FRAILTY: Geriatricians have become very aware that older persons pass through a state of frailty before they become disabled. Frail persons have a combination of weight loss, decreased strength or activity, fatigue and multiple minor illnesses. Emerging evidence suggests that aggressive treatment of frailty may prevent disability from occurring. Treatment includes resistance exercise, increased protein in the diet and perhaps anabolic steroids. Testosterone, together with a protein-calorie drink, decreases hospitalisation. Testosterone improves function in older men and women with heart failure. A new anabolic steroid developed by GTx in Memphis almost looks like “exercise in a pill”.

3. Dabigatran: This drug which works as well as warfarin for older persons who need their blood thining, does not require regular blood sampling to maintain appropriate levels. It may have less side effects as well. The disadvantage is it needs to be taken twice a day. However, for both patients and physicians this drug appears to be likely to greatly improve quality of life.

4. Vitamin D: It is now recognized that the majority of older persons have low blood levels of the sunshine vitamin. Increasing these levels decreases falls, improves function, decreases hip fracture and decreases the chance of dying. Vitamin D is truly the vitamin of the decade.

5. Delirium Intensive Care Units: Older persons with delirium have poor outcomes in hospital. The development of Delirium Units at St Louis University and Des Peres hospitals by my colleague, Dr Joseph Flaherty, has markedly improved outcomes. This along with other system improvements for older persons has lead to more pleasant and happier hospital stays for older people.

6. Stem Cells for the Heart: A number of studies have shown that umbilical stem cells decrease subsequent heart attacks and may reverse hear failure. Fish oil (DHA and EPA) appears to be the miracle drug for heart disease.

7.Alzheimer’s Disease: The recognition that exercise appears to be as effective as available drugs to treat dementia opens the way for the development of new drugs. A number of candidates are being developed including our one (an antisense to Amyloid Precursor Protein developed at the St Louis Veteran’s Administration). The new screening test for dementia and predementia developed at Saint Louis University and the VA represents an important step forward in the early identification of persons at risk for Alzheimer’s disease. This can be coupled with a new skin test being developed for Alzheimer’s disease.

8.Reducing use of therapeutic drugs in older persons: Drugs are over utilized in the United States both by patients and physicians. It is now being recognized that over treatment can be as bad as under treatment. The Cochrane collaboration found that most older people have their blood pressure over treated. Antipsychotic drugs which are often used to treat behavioral problems in older persons have been shown to increase the death rate. One of our medical students actually found that exercise done three times a week was highly effective at reducing the need for drugs for agitation. Geriatricians specialize in reducing drugs.

9. Recognizing the Role of the Caregiver: The wonderful work done by families, certified nurse aides and others, looking after older persons in need of help is being much more recognized. These persons are the true angels of health care and are totally under reimbursed. The importance of high quality support groups such as those run by the Alzheimer’s Association ( or 1-800-272 3900) has been recognized.

10. Recognition of Palliative Care: Slowly physicians and patients are recognizing that appropriate palliative and hospice care can allow us to go “gentle into the good night”. The Veterans Administration has been a leader in developing superb end of life care. Studies have shown that withdrawal of care at the right time may not only improve quality of our last days but may even extend life. So I guess I should thank Mr Limbaugh and governor Palin for their ridiculous characterisation of “death panels” as it gave an opportunity for more rational comments on palliative care to appear in the mainstream media.

I invite those of you reading this to comment on what you see as the major advances of the last decade.

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A Half Decision Lays the Plan for Future Legislation.

The Montana Supreme Court could have answered the question once and for all but chose to side-step it. Robert Baxter, four Catholic Doctors and the nation's largest aid in dying advocacy group, Compassion and Choices, asked the court to determine that aid in dying was constitutional. Instead the court said it determined that nothing in the laws prohibited it.

The state argued that the issue should be taken up by the legislature, not the courts, and conservatives have been yelling about "activist judges" ever since McCarter made the district ruling last December. Yet, if you view patients' rights - the rights to medical services by those in need - as a human rights issue, civil rights showed that rarely do legislatures work hard enough to protect minorities.

From Conservative lifenews, the new plans being laid for a legislative outlaw of aid in dying in Montana:

Helena, MT ( -- Reaction is coming in form pro-life advocates responding to today's decision by the Montana Supreme Court that determined there is no right to assisted suicide but saying it is allowed under state law. The pro-life activists say the decision is definitely bad but could have been worse.

The Montana Supreme Court, today, released its long-awaited decision in the Baxter case on assisted suicide.

In a 5-2 decision, the Supreme Court vacated the lower court's decision that found a constitutionally-guaranteed right to physician assisted suicide, and, instead, found the practice legal on statutory grounds.

In his dissenting opinion, Justice Jim Rice said that the majority badly misinterpreted our public policy. He said that assisting suicide has been explicitly and expressly prohibited by Montana law for the past 114 years.

Jeff Laszloffy of the Montana Family Foundation told, "Definitely not what we wanted, but not as bad as it could have been."

"While we would have preferred an outright reversal of the lower court's decision, this ruling is a partial victory," he explained. "The fact that the Court did not find a constitutional right to physician assisted suicide is good for those of us opposed to this abhorrent practice."

The pro-family leader told that the legislature should now get involved.

"What the court did, in essence, was to place the issue back into the hands of the legislature, where it should be," he said. "They said there's nothing currently in statute that prohibits the practice. It's now up to us to go into the next legislative session fully armed and ready to pass statutory language that says, once and for all, that physician assisted suicide is illegal in Montana."

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NPR on Baxter v. Montana.

From NPRs Frank James:

The Montana Supreme Court upheld a lower court's decision that nothing in state law bars physician-assisted suicide so long as the decision is made by a mentally competent, terminally ill adult who ultimately decides whether or not to end his life.

The Montana attorney general had appealed a lower court ruling, arguing that physician-assisted suicide was against "public policy."

But the state's supreme court said:

... We find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy. The "against public policy" exception to consent has been interpreted by this Court as applicable to violent breaches of the public peace. Physician aid in dying does not satisfy that definition. We also find nothing in the plain language of Montana statutes indicating that physician aid in dying is against public policy. In physician aid in dying, the patient-- not the physician--commits the final death-causing act by self-administering a lethal dose of medicine.

The case was a posthumous victory for Robert Baxter, a retired truck driver suffering from lymphocytic leukemia who died late last year.

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