Polite Dissent

We’ve set up a nice play area in the basement for the kids. It has a puzzle-piece foam floor, ball pit, play house, and an assortment of toys, many left over from when my wife used to teach kindergarten and first grade.

Last night, the son and I were playing with one of these toys, an assortment of colored plastic frogs you string like a necklace. My wife wandered over and saw what we were doing.

“You’re supposed to make a pattern with the frogs,” she said.

“I am making a pattern,” I insisted.

“It’s a Fibonacci sequence,” I continued. “They’re Fibonacci frogs.”

“Fibonacci frogs!” the son yelled in agreement, loudly and happily, as two year-olds are wont to do.

At which point she just rolled her eyes and wisely walked away.

Sam Guthrie, a.k.a. Cannonball, takes on Tsung, who has the “mutant gene for murder” and a handy supply of virtual bullets. Sam’s own mutant blast field protects him from the virtual bullets, but the feedback causes its own share of problems.

Why yes, this is from the Warren Ellis era of X-Force, why do you ask?

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed x-force cannonball sam guthrie warren ellis

Mickey Mouse Magazine, Vol 4 #10 (July 1939)

A comic book public service ad that start’s out with a pun in the title? Can that be a good sign?

No, not really. It’s not a bad PSA, just uninspired, and the morose penciling of Bernard Baily doesn’t help either.

Click on the image for the full ad

For your edification, here are the take home points from this PSA. Print them out and carry them with you at all times:

This PSA appeared in DC comics published in May 1961. The script was by Jack Schiff with art by Bernard Baily.

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Tags: comics psa eye fireworks rocket jack schiff bernard baily

How to tell if you’re not cut out for a career in Super-villainy in five easy steps, courtesy of the Human Flying Fish:

1A. Your partner is named after plankton.
1B. He claims to be an “Aquamanologist.”

2A. He’s a surgeon and an expert in marine biology, but thinks crime is the best way to make money.
2B. You cheerfully agree to be a guinea-pig

3. Your lungs are converted to gills, yet the oxygen and anesthesia during the operation are still being fed to your lungs. Oops.

4. Same theme: the operation replaced your lungs with gills, so why are still breathing air?

5A. Your costume consists of yellow hood and leggings and a purple and white tunic.
5B. You think “The Human Flying Fish” is a good name.

Images from the original appearance of the Human Flying Fish in Adventure Comics #272

Even space aliens are no match for the power of…Psychology!

from Tales of Suspense #15 (March 1961)

In X-Men Unlimited #41, a young mutant has unknowingly developed the power to release emotion-controlling pheromones. In this scene, his viewing of a horror movie has unanticipated affects upon his fellow moviegoers.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed x-men unlimited pheromeone

I wrote this post a little over five years ago, but I think it is just as important now as it was then. It gives non-physicians a few quick guidelines on how to tell legitimate studies from nonsense studies when they are reported in the press. I originally wrote in about newspapers, but it replies equally well to television news programs and internet news sites.

Almost every day it seems that a new groundbreaking medical reports is mentioned in a front page newspaper article or on the cover of a weekly magazine. The claims are bold: eating red meat leads to colon cancer, drinking soda leads to diabetes, green tea extract cures strokes and so on. But are any of these claims legitimate?

Medicine can be a confusing field, and statistics even more so. T-scores? Z-scores? Power? P value? How is a non-physician (or non-statistician) supposed to find out which reports are reasonable and which are unfounded?

It’s not that difficult if you remember to be skeptical and follow these two simple rules.

Skepticism is Your Friend
Approach all medical articles with a great deal of skepticism. These articles and reports are trying to convince you to do something different, such as eat less of this or that or take this vitamin or medicine. Don’t just take their word at it. Make them prove it to you.

Rule #1
Where was the study published? To be believable, it should have been published in a well-known, well-respected medical or scientific journal*. These journals include the Journal of the American Medical Association (JAMA), the New England Journal of Medicine and Lancet.

Be very wary if the report is from a presentation at a conference and has not been published. Published articles are closely examined and reviewed by experts. The same doesn’t necessarily hold true for a presentation.

Don’t trust a news release or report put out that is not published in a legitimate journal, or at least presented at a legitimate conference. Most suspicious advice, sloppy science and bad medicine comes from these “reports” (and the most eye catching headlines too).

(I would also add that readers should beware medicine by press report. A legitimate finding should be available in a journal that is currently available or one that will be shortly available. If no publication or pending publication is mentioned, then it is likely medicine by PR and less likely to be legitimate)

Rule #2
Look at the number of participants in the study. If it is for a well-known condition (such as heart disease, stroke or cancer) or addresses a common situation (diet, exercise) then there should be several hundred, if not thousands, of participants. A study that addresses a common condition or makes sweeping statements yet only has a hundred — or fewer — participants should be viewed extremely skeptically.

Following these two rules will allow you to efficiently separate the wheat from the chaff and discover which newspaper medical reports you really need to pay attention to, and which can be dropped at the bottom of the birdcage.

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* That is not to say that smaller medical journals don’t produce quality groundbreaking articles; they do, but it is rare. Big name journals also publish poor papers from time to time. Still, if it is published in a journal even a non-physician has heard of, then it’s more likely to be believable and legitimate.

This week’s comic book public service ad is more apropos than ever with the recent surge in popularity of the “staycation.”

Throw in a little country mouse/city mouse and what more do you need? Perfect PSA.

Click on the image for the full-sized ad
This was one of the later — and in my opinion, uninspired — PSAs that appeared in the tail end of DC’s monthly PSA program. Written by Jack Schiff with art by Sheldon Moldoff, it can be found in DC comics published in August 1965.

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Tags: comics psa summer vacation city country jack schiff sheldon moldoff

Batman: Shadow of the Bat #77 “Arwin’s Theory of Devolution”
Alan Grant, writer
Mark Buckingham, penciler

Streptomycin, a potent antibiotic, will indeed kill off the bacteria E. coli — and it’s particularly effective in a Petri dish, where you don’t have to worry about nasty side effects such as kidney damage and deafness commonly seen with such antibiotics.

However, the description of how the bacteria evolve resistance to the antibiotic is a little off:

The mutation in question (resistance to Streptomycin) occurred before the antibiotic was ever added. It may be a recent mutation, or it may be an old one, but when it occurred isn’t important — all that matters is that some bacteria in the dish have the mutated gene and are resistant to the antibiotic.

Once the Streptomycin is added to the dish, the non-mutated bacteria — those susceptible to the antibiotic — die off, leaving only the mutated bacteria to reproduce.

The surviving bacteria don’t “mutate rapidly” to pass along the gene because simply being one of the few bacteria that survived guarantees that their genes will be passed to the next generation. In other words, the mutation has already occurred, no more is required for survival¹.

In all fairness to the writer, these words are spoken by a college professor who is clearly more than a little nuts. So it is likely the character who misstates the science, and not Grant.

Notes:
1. There will of course be the usual random assortment of new mutations that may occur within any generation of bacteria.

Superman #701 “Grounded, Part One”
J. Michael Straczynski, writer
Eddy Barrows, artist

Kevin does a good job discussing the meat of Superman #701. There’s not much that I can add, other than to take a more in depth look at one particular scene — you know which one I’m talking about — from a medical perspective.

Yes, you read that right. Superman just told an elderly man that he has a serious heart condition, and then runs off, leaving the man to fend for himself. Wasn’t this journey across the country supposed to help him reconnect with the little guy?

One of three things is likely going on with the elderly gentleman:

1. The gentleman is suffering from angina (severely decreased blood flow to the heart due to narrowed or blocked arteries) or an early heart attack (a complete blockage of blood flow in one or more of the arteries supplying the heart). The pain and the man’s slumped position in the chair fit this diagnosis, but Superman’s comment doesn’t.

2. The gentleman has a dangerously irregular heart rhythm. Brief episodes of an irregular rhythm are fairly common — everybody has them — and generally nothing to worry about. But when you combine an irregular rhythm with chest pain, then there is something more serious going on (ventricular tachycardia or an advanced heart block would be my guess).

3. A combination of 1. and 2. An irregular rhythm could be cutting blood flow to the heart, leading to angina or a heart attack.

In any case, all of these situations qualify as a medical emergency — as in call 911 or proceed immediately to the nearest emergency room. Do not pass Go. Do not collect $200. This is not the time for you to scrounge for the doctor’s phone number; this is when you need to be calling 911. Or better yet, Superman could spend 2-3 minutes flying you to the emergency room. If he has several hours to spend talking a suicidal girl off a ledge, he can spend a few minutes saving an old man’s life (remember, not saving a man’s life is what led Superman into this predicament in the first place.)

And if it is angina or a heart attack, the last thing Superman needs to due is give the guy an adrenalin rush, increasing the blood requirements of the heart even more. Nice going, Superman.

As I discussed last time, while Superman has the ability to detect medical abnormalities, I am not convinced he has the skill to be able to interpret what he finds. It’s easy to misread heart rhythms, for better or for worse. If you haven’t had appropriate medical training, it’s also easy to miss the potential complications of certain diagnosis. For instance, Superman might diagnose the man with atrial fibrillation — a type of abnormal heart rhythm — but due to his inexperience, he wouldn’t know to look for a blood clot in the heart, a potentially fatal complication of atrial fibrillation.

True story: I had a case a few weeks ago, where a patient of mine was in a minor fender bender. The EMTs at the scene ran a rhythm strip and told him that he had an irregular heart beat and needed to see his doctor right away. First thing the next morning, the patient was in to see me, panicked, rhythm strip clutched tightly in his hand. He was convinced something was seriously wrong with his heart. A brief look at the rhythm strip quickly showed nothing was wrong. He had respiratory sinus arrhythmia, which means that the heart speeds up and slows down as the patient breathes in and out. It’s a completely normal finding and is nothing to worry about at all; the poor patient had been panicked, and undoubtedly lost a night’s sleep, for no reason. Thankfully, this story had a happy ending, but it shows that having the ability to check the heart rhythm is not the same thing as knowing what it means.

Another Maxwell Lord psychic-nosebleed cover. Enough already — this “Maxwell Lord is evil and psychic and his nose bleeds” theme has played itself out, at least as far as visuals go. Time to move on.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed maxwell lord justice league

It’s refreshing to see a villain who cares enough about his work to actually take the time to get a patent on his schtick. Given the speed with which the patent office works, that means he probably applied about five years before he finally got the chance to go on his crime spree. (Of course, in this case, it’s a nightmare-inducing gas, so you’d think Scarecrow and Hugo Strange might have somthing to say about prior art).

This week’s public service advertisement theme is “nature” — a fairly common theme among DC Comics’ PSAs. In this ad, a trio of boys are stopped from throwing junk in a river by a fly fisherman, who then goes on to tell them at great length about sewage treatment facilities, power plants, and agricultural chemicals. In an effort to get him to stop talking, the teens agree to clean up the river.

Click on the image for the full ad

The teens walked all the way to the river carrying a large empty box, a bottle, and a tin can just so they can throw them in the water? There have got to be easier ways to litter — or better yet, recycle.

I’m not big on “organic foods” — for the most point I think they’re vastly overpriced for the alleged benefits — but that crop scene make me want to reconsider.

“keeping sewage from having to go into nearby rivers and bays…” is an awkwardly worded, yet frightening, line.

This is one of the few PSAs where the title doesn’t end in an exclamation point.

For more nature PSAs, check out Get A Box Seat to Nature’s Wonders!, Nature’s Prize Pupil!, Nature Loves a Nature Lover!, and Teddy Roosevelt – Guardian of Nature

This PSA appeared in DC comics from September 1965. The script and art were by frequent collaborators Jack Schiff and Sheldon Moldoff.

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Tags: comics psa nature river jack schiff sheldon moldoff

Click on the image for the full ad

Let’s take another look at Shadow of the Bat #50, where Batman is facing Narcosis, a villain who has created a special gas — a “patented” combination of Ketamine and Acetylcholine — to cause horrific nightmares.

First, the Ketamine:

Ketamine is a sedative and an anesthetic which I’ve covered extensively before. It is a strong tranquilizer and it has been known to cause nightmares, so its inclusion in Narcosis’ nightmare gas makes a certain amount of sense.

Now the Acetylcholine:

Acetylcholine is a neurotransmitter. In other words, it is a chemical messenger used to pass information between two nerves and it is also used to pass information between nerves and muscles. It has multiple effects within the human body. It causes skeletal muscles to contract. It activates the parasympathetic nervous system which, among other things, increase gland excretions and cause the heart to slow down. Within the brain itself, acetylcholine is associated with REM sleep — a state known for its vivid dreams — but its exact effect is not entirely clear. When the body moves from other stages of sleep into REM sleep, acetylcholine production — which had been suppressed — increases, so there is a rise in the level of acetylcholine. Dreaming also increases in REM sleep, but there is mixed evidence that it is the acetylcholine itself that causes the dreams. Some researchers say acetylcholine causes dreams, some say it causes REM sleep, some say it’s the other way around, and some say it’s all just coincidence. For now, I’ll just point out that while it’s true that all three situations (REM sleep, vivid dreaming, high levels of acetylcholine) exist at the same time, correlation does not equal causation. I’d give Narcosis a mixed grade on this (if the acetylcholine gets to the brain, it may cause increased dreaming which may cause nightmares) except for one thing:

The bigger problem with Narcosis’ use of acetylcholine in his gas is the effects of the neurotransmitter on the other parts of the body. Sure, it might cause nightmares, but who cares when you’re having severe cholinergic symptoms (salivation, urination, lacrimation, defecation, nausea, vomiting), uncontrollable muscle convulsions, and cardiac symptoms. Frankly, nightmares are the least of your worries.

In this scene from the X-Women one shot, Rachel Summers is forcefully impressing her memories upon Kitty Pryde. As the art (especially the rendering of Kitty Pryde) makes abundantly clear, this comic is drawn by none other than Milo Manara.

It actually makes sense, if you think about it: Over the past decade, Claremont’s X-Men stories have degenerated into little more than soft-core bondage fantasies (c.f. any issue of X-Treme X-Men), so Manara is the perfect artist for him.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed x-men kitty pryde rachel summers claremont manara

Here’s an interesting situation: Green Lantern is captured by his enemies and placed in a special forcefield that causes severe pain any time he uses his ring. In order to escape, he uses his ring’s power to create a pill (a green pill, of course), a “highly concentrated pain-killer – a super aspirin!”

Hal swallows the pill and then waits a few minutes for it to kick in. Once it does, it blocks enough of the pain for him to escape the force field.

In other words, Green Lantern used his ring to:
1. Create a drug.
2. And it’s a drug that persists even after he stops concentrating on it. Shouldn’t the drug molecules (green, of course) and their effects evaporate once he stops focusing on them?
3. Pain killers, particularly strong ones, are difficult medicines to create — especially if you want to avoid side effects like sedation or nausea. Would Hal Jordan, a test pilot, know enough to create a super-aspirin? Or can he just tell his ring: make me a super pain killer and poof! it does?
4. Or maybe Hal just created a super-placebo?

(On the other hand, bonus points to Hal for giving the pill time to take effect rather than assuming it would work instantly, a common misconception. Medications, particularly oral ones, take time to kick in.)

Images from Green Lantern #69 (June 1969) by John Broome and Gil Kane.
More can be read here.

Another Binky public service ad — actually his second PSA featuring the theme of how to spend a constructive summer. The initial PSA dealt with Binky’s friends; this PSA deals with Binky’s younger brother (he of the enormous bowtie): Allergy.

Click on the image for the full ad

“Uncle Binky” — that’s a more than a little creepy. I foresee the little blond girl ending up in therapy years later telling stories about her “uncle.”

Speaking of creepy, I suspect that monkey puppet will be a thing of nightmares.

This public service ad is found in DC comics from April 1956. The script is by Jack Schiff and has art by Win Mortimer.

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Tags: comics psa binky allergy belong summer jack schiff win mortimer

Click on the image for the full ad

Quack diet aids are nothing new — here’s an ad from Captain America Comics #69 (November 1948) touting “Protam.”

I sure would love to know what, if anything, Protam was. The ad is little help — it tells us what Protam isn’t more than what it is: No drugs. No starvation. No exercise. No massage. Nothing to wear (does this mean they’re naked?). Not a drug. Not a laxative. Not a Thyroid.

The ad throws in a bunch of interesting claims and statements:
It works “even if burdened with Fat for many years (illness excepted).”
Drastically cuts down fat producing calories (But what about calorie producing fat?)
Lose Ugly Fat Economically, Simply, Pleasantly.
Protam Plan Good for Ladies, Too. (But not so good for verbs, apparently).
Sorry, no Canadian orders. (Damn Canada and their truth in advertising laws! OK, that’s just a guess…)

Protam wasn’t just advertised in comics, but in magazines such as Popular Science as well.

What exactly goes into Joker Toxin (aka Joker Venom, Smile Venom, Joker Juice, and sometimes, Smilex)? The recipe seems to have changed over the years:

1991
HUNTRESS: “Just tell me if any dimethyl silicate has changed hands lately. You know it Charley -– the poison the Joker makes his Smile Venom from.”
Dimemethyl silicate is most commonly found in cosmetics. For instance, it’s a common ingredient in lip gloss.
Source: Wonder Woman #282 (Admittedly, this story takes place on Earth-2)

1993
BRUCE WAYNE: “Some strange compound of chlorides and hydrocolloids with a protein catalyst.”
This one is little more than medical technobabble as all three terms, while real, are maddeningly vague. (FYI: Wikipedia entries on chlorides and hydrocolloids).
Source: Batman: Legends of the Dark Knight #50

2006
DR KOWALSKI: “I had never seen anything like the neurotoxin before. It blocked the calcium and potassium channels and also placed the victim in anaphylactic shock.”
More technobabble, but, like the best technobabble, there is just enough real science present to give it a whiff of truth: calcium channels are found throughout the body, but are especially common in nerves and muscles, and potassium channels are found in nerves and the heart muscle. Anaphylactic shock is a fatal allergic reaction — for example, people who die from bee stings.
Source: Batman: Legends of the Dark Knight #200

2010
BATMAN: “The most lethal element of authentic Joker Venom, hydrogen cyanide, is absent. strychnodide is present, though. It causes the muscle contractions that produce the hallmark grin.”
Hydrogen cyanide is a very real, very fast, and very deadly toxin (its symptoms don’t really match Joker Venom though). Strychnodide is a fictional derivative of strychnine.
Source: Detective Comics #867.
Though this is the first mention (to my knowledge) of this Joker Venom recipe in an actual comic, this combination of toxins was first mentioned in a DC Heroes Role Playing Game supplement in back in 1993 (DC Technical Manual: S.T.A.R. Labs 1993 Annual Report — I scanned in the relevant section here.).