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Saturday, October 18, 2003
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 Saturday, October 18, 2003
started 10/20/2003; 2:34:03 PM - last post 10/24/2003; 1:11:42 PM
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Doc Searls - Saturday, October 18, 2003 
10/20/2003; 6:34:03 PM (reads: 6504, responses: 7)
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Cross-promotion 
ourPod
| | Imagine an iPod that listens to FM, records off the air, and transmits as well. That's wht the new Napster 'pod does, it says here. |
20,000
| | That's the number of jobs, it says here, that Sony will cut. |
Is there a word for Fear of Oppportunity?
| | Howard Rheingold was here in Santa Barbara a few days ago. I missed him, but my wife got to say hi (and report that he gave a great talk). |
| | The multimedia messaging service era is just beginning, but it's already created a monster. That monster is mobile blogging (m-blogging or moblogging to some). Right now, it's a pretty small monster, but in the coming years, it has potential to wreak havoc on everything from carriers' marketing plans to their billing systems. |
| | The power of its threat is that when groups of users employ their wireless phones to coordinate collective activities — an application that may not have been imagined by the carriers themselves — the industry will have to learn to respond quickly, with new pricing structures, promotional strategies, service reliability guarantees and network management gymnastics. |
| | "Mobile blogging can create a lot of new service options," said Eric Anderson, vice president of practice development at Ericsson USA. "It's almost like the network operator is not 100% in control of what hits their network anymore. Blogging users can use the phone in ways we hadn't thought about, allowing those small groups of users to be great influences." |
| | Will the providers take advantage of the opportunities here? Aren't these the same guys who block port 80 and port 25 in their high speed internet services to homes? |
| | Be interesting to see where this goes. |
Bromide, cont'd
| | The paragraphs that follow were written a couple weeks ago. I put them up briefly, then yanked them because I rememberd that one of us (a well-known blogger who probably would read this) was going into surgery shortly, and I didn't want to freak them out. Warning: If you're about to go into surgery involving general anesthesia, you might want to skip this post. |
| | The day our friend Susan died, I received a pointer to this item in the New York Times. (If that link doesn't work, here's another to the same basic story.) It's about pancuronium bromide, the lethal chemical used to execute prisoners in many states. Pancuronium bromide is coincidentally among the portfolio of poisons with which anesthesiologists cause a patient's body to stop breathing while mechanical ventillators take over the same function. By itself pancuronium bromide does not stop consciousness. In executions it will cause the prisoner to die of asphyxiation, unable even to blink while the brain gradually passes out from oxygen starvation. This, some complain, is cruel and unsual, even if the drug is mixed with others that stop consciousness before asphyxiation occurs. |
| | Reading the piece gives me chills, because I had my own horrifying experience with the misadministration of pancuronium bromide, or something very much like it, before hernia surgery in 1996. Laying on the operating table waiting to fall asleep, I found myself fully awake and unable to breathe, or even to move the tiniest muscle. I wanted to scream but couldn't make a sound. It felt as if a vast invisible blanket lay over me; that I was buried alive in full view of clueless professionals who were about to carry out several hours of surgery while assuming I was asleep even though I was not. I don't know how long I lay awake like this, but it was long enough to experience the Xtreme level of fear best expressed by Edgar Allen Poe in in The Premature Burial — or worse, by the 1961 Roger Corman movie with the same title, starring Ray Milland. At times like this, these associations come to mind. |
| | The surgery was successful, but I awoke in a state of delerium that only cleared when memories of the event flashed back into my head. When I finally became coherent enough to reconstruct all the known events, I confronted the anesthesiologist. |
| | He admitted a mistake. Even though I had told him before the surgery that I don't react normally to many drugs (owing to an obscure and otherwise unimportant blood disorder), he said he ignored my input and handed the job off to a subordinate. "But she did notice that in fact you were still awake before the surgery, and she did put you to sleep. You were never in any danger." True, but the experience was no fun, and it contributed plenty of doubt to my already shaky faith in the medical profession. |
| | Mistakes in medicine are worse than common. They're standard. We live and die by statistical rules for which success is the generally (but not entirely reliable) exception. We usually survive. But not always. Imagine if you knew that one out of every 100 drivers coming your way would hit you; but that you also have little choice but to drive if you want to live. That's how the bargain goes. |
| | By the way, we still don't know why Susan died, since the toxicology reports aren't back yet. Our best nonprofessional guess (by process of the autopsy having eliminated just about every other possibility) is that her death was caused by some kind of delayed effect of the anesthesia. But in fact all we know is that she just stopped breathing, and that she was not being monitored by maninery or nursing at the time. This is standard in the U.S.today, when surgery involving general anesthesia is routinely done on an outpatient basis.You can draw your own conclusions about that one. |
Intelligent agency
| | Buzz is on the phone, quoting something Feedster's Scott Johnson said over dinner in Boston last night, about the RSS+aggregator-enabled blog world. What Scott said (Buzz says) was, |
| | The people I read are my intelligent agents. |
| | Context... Remember the "intelligent agents" scare from a few years back? (Wonder how much VC money got wasted on that one?) Never happened. (Not in a big way, anyhow. Are you using one now? I mean, in addition to the ones you read in your aggregator? See what I mean?) |
| | Now, thanks to RSS, it's happening. |
| | Makes me think back to Doug Engelbart's thinking about augmenting human intelligence, and how the best augmentation in fact comes from other connected human beings. |
Neoblogism
I was overseen to have said...
Conserving journalism
| | Jay Rosen is becoming Required Reading, if you care about What It Is and What It's Doing.. He's a professor at NYU, where he chairs the Dept. of Journalism & Mass Communications, and his credentials are first rate. So are the intentions embodied his blog, which is subtitled Ghost of Democracy in the Media Machine. |
| | What Jay writes matters because we're still leaning here, and the dude is an ace teacher. Dig this from his September 19 interview with Merrill Brown: |
| | It is not a straightforward matter to learn what technology can do for storytelling. Which brings up newsroom learning and the staff¹s intellectual capital. Journalism the American way presents some major hazards for the worker¹s mind. Newsrooms have never known as good learning environments. They¹re too busy! Professional development and training have never been priorities in the news business. This is strange because human capital is increasingly important there, as it is everywhere in the knowledge fields. |
| | Whether you're a professional journalist or not, development is an unavoidable consequence of reading Jay. |
discuss
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Shelley - Re: Saturday, October 18, 2003
10/20/2003; 10:20:15 PM (reads: 1143, responses: 0)
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I am glad you didn't say anything at the time, though luckily I was attended by a pretty sharp and efficient surgical team. They even practiced the new psychological procedure of every member coming in and meeting and touching the patient before surgery, patting an arm, hand on leg or shaking hands, or variations thereof -- this is shown to increase success of surgery as well as healing of patient.
One problem that comes up with day surgery is that people with sleep apnea can have adverse effects from general anethesia -- effects that can occur late into that evening, without warning. Since most people who have sleep apnea are not aware they do, day surgery is riskier than the medical profession -- and the medical insurers -- would have people know.
It's not unusual for women to develop sleep apnea as they get older, and they don't always have outward symptoms -- such as the snoring we hear about. Women who have some weight problems are more at risk for sleep apnea -- it is not a 'male' thing.
I am sorry for your friend, Doc. She sounds a very special person.
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enoch choi - Re: Susan, your paralysis, and commenting on physicians
10/20/2003; 11:01:09 PM (reads: 975, responses: 0)
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i posted a reply on my blog:
http://www.enochchoi.com/thoughts/archives/000307.html
my condolences to you again for your friend Susan, and i'm angry that you experienced paralysis without sedation...
i was wondering if you could add to my thinking on this matter: Is there a good way for us to aggregate comments on experiences we have with physicians, the way that we can review books on allconsuming.net?
When googling on "Palo Alto" and "urgent care" I find people that have blogged in increasing frequency on their experience with our clinic (mostly positive). There's no easy way to find these though, since they're scattered between search results on public service announcements and ads.
Without creating a service built on some external index like a physician's state licence #(like allconsuming.net is on ISBN), is there another way? The index approach would only work per physician anyways, not allowing a patient to comment on a clinic as a whole. I was thinking of coding a blog entry with the GeoURL data of the clinic, but that's pretty geeky for now and not intuitive at all. If every physician had their own blog, you could use trackbacks, but that's pie in the sky as well, since very few docs blog.
I'm looking for a distributed way, not a centralized service like ePinions. I want the opinions expressed to be clearly the patient's own.
It'd be a step towards a service Marc Canter has been pushing for, OpenReviews, envisioned as a way to express your a short opinion without having to post a blog entry, etc.
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Doc...
Interesting thoughts although I suppose I have a slightly different perspective on the subject. Regardless, a book I highly recommend on the subject is Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science. Here's an excerpt worth reading, an interview, and a speech with audio.
A quote from an interview I think is worth quoting:
"I think we're at a difficult juncture. On the one hand, medicine has become extraordinarily aggressive and bewildering and also powerful, in the sense that it is capable of truly extending people's lives, whether they have heart disease or kidney failure or even cancer. On the other hand, patients are being asked to make more choices and take on responsibilities of a greater magnitude than they ever have had to before. And that's because we have finally come to grips with the notion that, okay, doctors are not gods. But what comes after that? No one has really prepared anyone for this, and I think that's because we've never really shown people how medicine works: what decisions really matter, how they're made, how much uncertainty there is, how that uncertainty is dealt with. The thing that most startled me upon entering the medical profession is how human an endeavor it is. We have all the technology and studies and science and know-how and yet, in the end, it's still this tiny pair—the individual doctor and the individual patient—who are left to try to sort through it all. It's the decisions that are really critical. And those decisions are inherently imperfect because both doctor and patient are fallible, because there are still mysteries in medicine—things that we don't understand—and because there is always going to be uncertainty." - Atul Gawande
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Doc Searls - Re: Bromide
10/21/2003; 3:14:09 PM (reads: 1136, responses: 3)
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What it comes down to is this: We think the risks of surgery are acceptably low. Yet they are much higher, for many common procedures, than those for, say, driving. And they go up fast if you're old, obese or unusual in other ways. We're not just dealing with fallibility here, or uncertainty; although we have plenty of both. We're talking about known and well-calculated risks that we rationalize to easily.
I also have a feeling that the deaths away from the hospital after "day surgery" are higher than we think. Don't know, though.
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enoch choi - Re: reporting on deaths following day surgery
10/23/2003; 10:58:55 PM (reads: 1117, responses: 2)
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http://www.enochchoi.com/thoughts/archives/000310.html
My understanding is that most surgeons are hypervigilant during the first few days, and also the first month, since all deaths are automatically reportable, and reviewed. This happens regardless of the cause for death, even if it's not due to the surgery.
Is mortality following day surgery underreported? I don't think so. I agree that it's riskier than driving, and that the risks are often not explained well enough prior to a procedure. But under-reported? I think they're probably over-estimated due to any death being lumped into an aggregate statistic.
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enoch choi - Re: reporting on deaths following day surgery
10/24/2003; 3:06:50 PM (reads: 1212, responses: 1)
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Doc posted comments on my site, i'll repeat my reply here:
I may be wrong (i'm not a surgeon), but the chain of events goes something like this:
1) any death 30 days after surgery has mandatory reporting to the coroner by the officer who pronounces the patient dead. unfortunately an autopsy is rarely done due to the lack of resources and the families' wishes
2) the surgeon's weekly MM&R "morbidity mortality & review" commitee at the hospital would have a list of deaths that occured and could choose to review the case
3) if suspicious, the State Medical Board that granted the surgeon the license to practice (usually under the office of consumer affairs) could investigate, or at least request records. Often this is done at the request of distraught family members.
4) Dr. Jacob Reider is an adviser to the NY state panel that does this, see his entry:
http://www.docnotes.net/2003/10/10.html#001606
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Doc Searls - Re: reporting on deaths following day surgery
10/24/2003; 5:11:42 PM (reads: 1237, responses: 0)
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Excellent information. Thanks!
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