bookofjoe

Chief Justice Mario M. Cuomo?

Last Wednesday I said in no uncertain terms that U.S. Supreme Court Chief Justice William H. Rehnquist would not be back on the bench when the Court returned yesterday.

He wasn't.

And he will probably never return.

It it almost certain that his thyroid cancer is the rarest and most lethal variety: anaplastic.

Dr. Steven I. Sherman, chair of the Department of Endocrine Neoplasia at the University of Texas M.D. Anderson Cancer Center in Houston, said that anaplastic cancer is "likely."

Sherman noted in this morning's Washington Post front-page story that anaplastic cancer kills patients on average within six months.

90% of such patients die within one year.

"I have had patients where you can mark on the skin with a pen the edge of the tumor and watch it grow day by day - it is that fast," said Sherman.

Dr. Leonard Wartofsky, chairman of the Department of Medicine at the Washington Hospital Center, said in the same article that in 35 years of treating thryroid cancer he had seen only two patients survive the anaplastic form.

The winner of today's Presidential election will appoint the next Chief Justice to take Rehnquist's place.

So today's election is not only for President, it's also for who leads the nation's judiciary, potentially for decades to come.

That's two of the three pillars of our government up for grabs as I write and you read this.

Profound, amazing, and almost unbelievable.

But true.

Martin Sammtleben - Please welcome my new Iceland correspondent

Just yesterday, after protracted, sometimes difficult negotiations, his people and my people reached agreement on the terms of a contract which provides for bookofjoe being the exclusive source for all news emanating from Martin Sammtleben out of the great country of Iceland.

How can a country founded c. 850-875 by fierce Norsemen and the Irish and Scottish girls they abducted not be great? But I digress.

How, you ask, did Martin obtain his coveted position?

Well - as always - there are two sides to the story.

My version is, I decided that since he's the only Icelander who's ever emailed me, he was clearly the best person for the job.

So I gave it to him last night.

Being the modest sort of man he is, at first he said he wasn't qualified.

Ha.

If he can fog a mirror with his breath, he's qualified.

Sorry, Martin.

But the bar just ain't that high.

Now to his first dispatch.

It came in last night, while I was sleeping.

This is another bookofjoe exclusive.

Man - what with the Toastabag yesterday, and now this, I feel like Clint Eastwood in

"Dirty Harry": what with all the excitement, I kind of lost track of where I was.

I digressed.

Now where was I?

Oh, yeah, Martin.

Martin reported - along with the photo evidence that leads this post - that a new volcanic eruption burst through the Vatnajökull glacier at 9:50 p.m. (Icelandic time) Sunday evening, October 31.

Being the thorough person he is, Martin furnished a

link to the website mapping the seismic activity.

Nice job, Martin.

To my readers: much as I'd like to share with you the details of Martin's contract, attorneys for both sides in the negotiations insisted they be kept confidential.

So if TheSmokingGun publishes the documents, hey - they didn't come from me.

This is what I see right now when I look up from the computer

You're looking at my backyard out my bedroom window, to the northwest.

About 25 miles away, visible through the trees if you're sitting here with me, are the Blue Ridge Mountains.

Yes, they really are blue.

To give you a sense of scale: the magnolia tree (the large dark green one to the left) is 90 feet tall.

Cornell University Ergonomics Website

Much to see and do here.

You could usefully - and quite happily - spend quite a bit of time here.

Good thing you're conscientious, and wouldn't dream of doing something like that on company time.

Ha.

BehindTheMedspeak: Obecalp

That's "placebo" spelled backward.

And it was the drug of choice for nightly visitors to the emergency room at Los Angeles County-University of Southern California Medical Center back when I was an intern.

We had a lot of patients, mostly destitute and alcoholic, who'd come in on a regular basis, complaining of this or that hurting.

I learned early on from the residents and attendings that in order to get people seen who really did have emergencies, a strict "5 minutes or 5 problems" rule had to be invoked for those who didn't.

That is, a patient had 5 minutes to tell his story, or he could name 5 problems, and then the physical examination began, no exceptions.

For these nightly regulars who wanted, above all, some sort of prescription, some medication, some pill, there was Obecalp.

We had Obecalp Red; Obecalp Green; Obecalp Yellow; and, for those resistant, impossible-to-treat patients, the über-capsule, Obecalp Purple.

Each Obecalp was a huge, powdered-dextrose[sugar]-filled capsule that a normal human could barely swallow.

Those purple ones were downright scary looking.

But they did the job of sending the patient away satisfied.

Think that's terrible, what we did?

Hey, we were simply decades ahead of our time.

Denise Grady wrote an article about the controversy that continually swirls around the use of placebos; it appeared in the September 28 New York Times Science section.

It follows.
_____________________

This Pill Will Make You Feel Better, but We're Not Sure Why

Most people have heard of the placebo effect, in which patients given sugar pills feel better because they think the pills are medicine.

But few would like to be on the receiving end of a placebo: a person who asks for a painkiller wants the real thing.

The medical profession, at least officially, frowns upon prescribing placebos, because it usually involves lying, implies disrespect and can destroy trust in doctors.

Some hospitals ban placebos, except in experiments, and then participants must be told that they might be given inert pills or shots.

A new survey, though, suggests that the profession may not always practice what it preaches.

In the survey, of 89 doctors and nurses in Israel, 60% said they had given patients placebos.

Many said placebos could sometimes work, and more than a third reported prescribing them as often as once a month.

The patients given fake medicine included women in labor and people suffering from pain, anxiety, agitation, vertigo, sleep problems, asthma and drug withdrawal.

Most had no idea that they were getting placebos.

Among the prescribers, 68% told patients they were receiving real medicine, 17% said nothing at all, 11% said the medicine was "nonspecific" and 4% told patients the truth.

Asked why they prescribed placebos, 43% said patients had made "unjustified" demands for medicine; 28% did it to test whether a patient's symptoms were real or imaginary; 15% hoped to buy time before the next dose of real medicine; and 11% said their reason was "to get the patient to stop complaining."

The doctors who conducted the survey said they had expected that no more than 10% of those who responded would have used placebos.

"This is apparently a common practice," said Dr. Pesach Lichtenberg, a psychiatrist at Herzog Hospital and Hadassah medical school in Jerusalem.

He conducted the survey, with Dr. Uriel Nitzan, at two large hospitals and various community clinics in the Jerusalem area.

Their report was published online on September 17 in the British Medical Journal.

The notion of a placebo effect dates at least as far back as Hippocrates, who observed that certain gravely ill people seemed to recover through sheer "contentment" with their doctors.

Thinking the mind could heal the body, later physicians sometimes tried to help it along by giving inert pills or powders to sick people they could not otherwise help.

Today, some researchers are studying the placebo effect, while others doubt that it even exists.

In a telephone interview, Dr. Lichtenberg said he thought the placebo effect was real, could sometimes help patients, and could do so more safely than many drugs.

"I think the placebo has a legitimate place in medical treatment," he said, but he added that it was wrong to lie to patients.

"There are certain ethical questions," he said.

"Do you tell a patient, 'I'm giving you an antibiotic or a painkiller,' when it's not? Or do you tell them, 'You are getting an agent which has been proven effective repeatedly in research, which will help you feel better; we're not exactly sure how it works, but it has been shown to cause changes in brain imaging, to have physiological effects in the body and we are confident you will get relief?' Do you say something like that?"

Dr. Lichtenberg said he became interested in the placebo effect because he had been helped by it himself.

He had suffered for years from repeated throat infections, and consulted a friend who practiced alternative medicine.

"He spoke to me for five hours," Dr. Lichtenberg said, recalling that he free associated about his throat and described being made to sing as a child for his elderly aunts.

The friend told him that he would become slightly ill and then recover.

That was exactly what happened, Dr. Lichtenberg said.

The experience convinced him that there was something to the placebo effect.

He said: "People in our day and age are surprised that a nonpharmacologic intervention could be useful, and I think that ultimately is the message of the placebo effect.

There are other ways of bringing comfort and succor to a suffering patient."

A survey of Danish doctors published in 2003 also found that many of them prescribed placebos, but Dr. Lichtenberg said it was not known whether doctors and nurses in other countries behaved the same way as those in Israel and Denmark.

Dr. Robert M. Wachter, chief of the medical service at the medical center at the University of California at San Francisco, said in an e-mail message, "The use of placebos in day-to-day clinical care is virtually unheard of in the United States."

He continued, "They are thought of as a subtle form of deception - both unethical and potentially creating a small risk of a malpractice suit."

But Dr. Wachter also said that every doctor knew about the placebo effect and that it accounted for much of the benefit people got from antidepressants and all of the benefit from antibiotics taken for viral infections, which are not affected by the drugs.

" 'Take this - I'm sure you'll feel much better' is a placebo maneuver," Dr. Wachter said.

"But in the U.S., it would be accompanied by a real medicine, not a sugar pill."

World's coolest motorcycle helmets: Troy Lee Designs

This Corona, California-based company creates unique, custom-painted helmets that can run up to $2,000.

No more worries about someone picking up the wrong one by mistake.

It someone does pick it up, it'll be by design.

Waycool.

BehindTheMedspeak: 'Quantum Zeno Effect'

It's named after the Greek philosopher Zeno, and was introduced into science by a group of physicists in 1977.

It means that a simple act of observation freezes a quantum system - brain activity, for instance - and suppresses certain transitions to other states, including gene expression.

Dr. Jeffrey Schwartz, a research professor at UCLA's Neuropsychiatric Institute, has been successfully treating people with obsessive-compulsive disorder (OCD) with a non-drug-based therapy employing such measures.

Says Schwartz, "Quantum physics asserts that all causation does not lie in matter. Physics doesn't integrate this with the brain, but we're bringing a new form of causation to science. It's a major paradigm shift of Copernican magnitude."

Schwartz's work has shown that positive thinking can permanently alter neural pathways.

"A change in perspective is a uniquely human capacity, and the regular paying of attention determines not only how the brain works but also how genes express themselves," he says.

His website offers more information about his approach to OCD, and much else.

It's worth a visit even if you don't make a list and check it twice, and then a third time, and a fourth, and one more time, and....

Free SMS - worldwide

SMS.ac has created a website enabling cellphone users to send and receive text messages for free.

They've got lots of other stuff going on too: the homepage's feature headings include Flirt, Interactive, Channels, Clubs, Mail, and Ringtones.

An excellent place to waste time, if I do say so myself.

No one's a better judge of such things than me.

Trust me.

You know what comes next - so for once, I'll skip it.

The company's been in the news for various borderline activities lately.

For example, they've created the Alibi and Excuse Club, now with over 7,500 members, to provide a live person to give you cover for doubtful undertakings.

Sounds like a club I might feel comfortable joining.

You too, probably, if you're here reading this.