Polite Dissent

With tomorrow being election day, this week’s public service ad focuses on elections — not voting, because the writer assumes that readers are too young to vote (and this was written and published well before the 26th Amendment) — but in getting others to vote.

Click on the image for the full ad

While overall this PSA has a positive “get out the vote!” message, it also showcases part of the unfortunate legacy of elections prior to the Voting Rights Act of 1965 (and numerous other Civil Rights legislation and court cases): the literacy test — one of the most common methods used to prevent minorities from voting.
Here’s a brief history and examples of the literacy tests used in Alabama and Lousiana.

This PSA can be found in DC comics from November 1956, and given it’s mentioning of dates in the PSA itself, was only published the one time. The script was by Jack Schiff. Both Win Mortimer and Bob Oksner are credited with the art at various places. I’m going to go with Win Mortimer as the pencils look more like his than Oksners and at this point in time, almost all the DC PSAs were done by Mortimer.

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Tags: comics psa election voting jack schiff win mortimerbob oksner

scene from Adventure Comics #230

Why is Wings getting all the congratulations and credit? Essentially, all he did was run away as fast as possible — it was Winnie who stayed by the “dangerous” gorilla and took all the risks.

A decent episode of Fringe, which — while it had a clever plot — was really more about setting future events in motion.

The Plot: In the alternate universe, a pair of criminals breaks into one of the amber quarantine zones and are able to successfully remove and resuscitate one of the trapped people. Unfortunately, they set off the alarms and one of the crooks becomes trapped when the amber-ifying gas is released into the area. The head thief and the rescuee — his twin brother — escape.

The Fringe Team is called in to investigate. They quickly realize that someone has escaped the amber and are able to identify him as Joshua Rose, a career criminal and bank robber. Joshua had invented a device that let him walk through walls to enter and rob a bank, but it also caused space-time instability and each of his break-ins had to be sealed in amber to protect the alternate universe from unraveling. In his final robbery, Joshua got trapped in the amber himself. Visiting his old house, the team learns that he has a twin brother. Agents Lincoln and Dunham pay the brother Matthew a visit, but he claims no knowledge of his Joshua’s whereabouts. Olivia is suspicious — with some prodding by Imaginary Peter, she realizes that Joshua and his twin have switched places. It was the good brother, Matthew, who was trapped in amber, and not Joshua. She confronts them, but they have already switched back so all the tests show only Matthew, the good brother.

Information comes to light suggesting the Joshua is planning another band robbery. Broyles sends Dunham home thinking she is under too much stress. She refuses to give up the case and talks to mentat Agent Farnsworth and deduces which bank Joshua is going to rob. She finds his hole-in-the-wall device, but is tasered from behind and knocked unconscious. Inside the bank, Matthew arrives to talk Joshua out of the robbery. Almost too late, he realizes that Joshua never really intended to rob the bank — just make it look like he was going to so that he would be trapped in amber, leaving Matthew free and clear to live his own life. Matthew is able to escape at the last minute. Dunham later confronts Matthew at his house and lets him know that she knows the truth, but after seeing him with his children, she decides to let the matter drop (though still is professional enough to bag the evidence).

During the episode, Dunham has been seeing more and more of Imaginary Peter who tells her that she is the Olivia of our world, not the alternate universe. Meanwhile, Walternate and alternate-Brandon convince her to enter an isolation chamber to see if she is able to jump universes. She is twice able to briefly return to our New York, and the second time finally realizes that Imaginary Peter has been telling her the truth and she is not Fauxlivia. She hides her realization of these facts from Walternate and Brandon.

1. Without a Paddle
I will say it yet again: do not shock a flatline. Despite what you see in television and movies, defibrillation does not “jump start” the heart. Instead, defibrillation shocks the heart with enough power to break through a bad rhythm and (hopefully) allow the heart’s normal rhythm to reassert itself. That’s why it’s called “defibrillating” – and in de (stopping) fibrillation (a particularly nasty heart rhythm). You can’t defibrillate a flatline because there is — by definition — no rhythm to break.
On the other hand, those were cool defibrillation paddles.

2. Alternaties:
“The stuff that dreams are made of” was spoken by Humphrey Bogart in The Maltese Falcon, though the quote actually dates back to Shakespeare’s The Tempest.
Nixon Parkway
October 17th, 1989 was the date of the big San Francisco earthquake — the one that disrupted the World Series.

3. Needs a Better Pharmacist
Of the three “psychotropic drugs” Olivia was given, only one (Elavil) can actually be considered psychotropic. Elavil is the brand name for the antidepressant amitriptyline, an older class of antidepressant (a tricyclic, as opposed to today’s SSRIs or SNRIs). A dose of 2000mg is enough to sedate an elephant. (As a side note, Elavil is not available by brand name in the US anymore, only as a generic). Neurontin is the brand name for the anti-seizure drug gabapentin, though it is also used for other conditions such as nerve injury or chronic pain. 5000mg is a whopping dose, though one of the Neurology attendings I worked with as a resident joked that you could safely prescribe Neurontin by the gram, so it may not be out of the realm of possibility. The third drug they didn’t mention, but which was shown on screen, was “synthetic dopamine” (no name brand used this time), a medication which is used to raise blood pressure during surgery or in severely ill patients. They had her dose listed as 130mg, which again is an incredibly high — and quite possibly fatal — dose as dopamine is usually prescribed in micrograms.

4. Sugar, Sugar
While there is a real Riverdale in the Bronx, whenever I hear Riverdale, I always think of Archie.

5. The Peter Principal
Olivia’s actions — for which she was congratulated by Broyles — accomplished nothing. If anything, she placed herself and fellow agents at risk with nothing to show for it. If she hadn’t intervened, Joshua would have pretended to rob the bank and get trapped in Amber. Matthew would have tried to talk him out of it, but escape in the end. With her intervention: the identical things happened. This should be the definitive proof this is the Olivia from our world: her incompetence shows through no matter which universe she is in.

6. The Kids are Alright?
So were Danielle and Joshua living (or least pretending to live) as husband and wife for the past four years? Surely the kids noticed something was amiss, and will notice that daddy is different now. After all, Joshua was their father for longer than Matthew (and probably is the only father they can remember).

This was a decent episode of Fringe. The rescuing someone from amber plot was good, as was the identical twin plot — they just didn’t gel as well as I thought they should. The medicine was disappointing (though it should be pointed out it really wasn’t any worse then most other sci-fi shows). Still, it was enough to move the Doomsday Clock up a minute to 11:55.

Tags: television fringe amber bank robbery defibrillate olivia

A relatively low scoring week with no frequent favorites mentioned.

This week, Steve had the high score with 6 points, followed by Oliver P and Sam Feldstein, both with 5 points.

Overall, Gary and Tippi are tied for the lead with 28 points. Jock M holds onto third with 24 points. Fran and Sapramiska are tied for fifth with 23 points. If your score is 17 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

An uninspired, uninteresting, and frankly boring episode of House. It’s as if it was written by someone who’s heard about the show, but never actually watched it.

Joe Dugan is the campaign manager for a senator running for re-election. After he develops severe itching and purpura (red/purple discolorations of the skin), he is admitted to House’s team for diagnosis and treatment. His liver functions (ALT and AST) are elevated and he is showing cryoglobulins (abnormal proteins that “thicken” the blood, especially when cold). There is no history of alcohol or drug abuse. The team’s initial diagnoses are hepatitis C (but the tests for hepatitis were negative), or a toxic exposure. A search of Dugan’s house reveals some unpasteurized apple cider, from which Foreman concludes that Dugan has an E. coli infection (there have indeed been multiple cases of E.coli from unpastuerized cider). House starts him on Aztreonam (an antibiotic) and plasmapheresis (to clean out the cryoglobulins). However, while the plasmapheresis is being set up, Dugan becomes paralyzed. The paralysis resolves after a few hours and Chase refers to it as a transient ischemic attack (also known as a “mini-stroke”). The differential diagnosis now consists of Wilson’s disease, a neuroendocrine tumor, or disseminated intravascular coagulation (DIC). House considers the last two both likely possibilities, so tests are run for both — and, of course, both tests are negative.

Luckily, a new symptom occurs: hematuria (blood in the urine), which the team takes as a sign of renal failure. TTP (thrombotic thrombocytopenic purpura) is suggested as a possible diagnosis, but discarded in favor of HSP (Henoch-Schönlein purpura). According to new team member Masters, the treatments for HSP are steroids or chemotherapy. House prefers the latter, but Dugan chooses to go for steroids instead. Nevertheless, House switches medications so he gets the chemotherapy after all. It’s all a moot point when Dugan develops yet another new symptom: pulmonary edema (fluid build up in the lungs). The team’s suspicions turns to infection, especially schistosomiasis, which Taub thinks Dugan might have caught from snails in his fish tank — except there are no snails there, so that idea is out. While at Dugan’s house, Foreman, Taub, and Chase are busted for breaking and entering and carted off the jail, so House turns to Masters for help coming up with a plausible differential diagnosis. They discuss primary sclerosing cholangitis (an inflammatory disease of the bile ducts) and cholecystitis (gallbladder disease), but neither quite fits. After seeing a press conference with the senator on television, House decides Dugan has hepatitis C which he must have caught from the Senator, since House saw signs of hepatitis infection in the senator. House tells Dugan that his negative test was a false negative and starts him on interferon, the a common treatment for hepatitis C. The interferon doesn’t work, so now House and Masters want to infect him with hepatitis A as this, according to a small study cited by Masters, cures 15% of people with hepatitis C. Of course, the other 85% died. Cuddy won’t let them proceed until they can prove Dugan has hepatitis C, but thanks to the false negative test and the subsequent plasmapheresis, the tests would all be negative. House is able to fake a positive test using blood from the senator. This convinces Cuddy and Dugan agrees to the hepatitis A protocol. As the episode ends, Dugan’s condition is already starting to improve.

As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

As I’ve mentioned before, hematuria (blood in the urine) is not a symptom of renal failure. It can be a symptom of many other kidney problems, but it is not the presenting symptom of renal failure.
You could argue that the patient showed oliguria (low urine output), which can be a symptom of renal failure. But Chase mentioned hematuria, so that’s what I’m going with.

Sharing cocaine/cocaine straws is not a risk factor for hepatitis c infection, which is for all intents and purposes a blood borne disease — unless House is suggesting they both used cocaine so much their noses were raw and bloody, and blood was exchanged this way.

Schistosomiasis is not a bacteria. It’s a parasite.

It’s entirely possible to have a neuroendocrine tumor without “diminished mental capacity” or “loss of judgment.” Pheochromocytoma (a neuroendocrine tumor) has been suggested many times as a plausible diagnosis on the show in people with normal mental function.
Neuroendocrine tumors can occur in the head/brain area, so a CT scan of the neck to abdomen might miss one.

I suspect somewhere out there is a paper which discusses hepatitis A infection curing hepatitis C, but if so, it’s fairly obscure (i.e. I couldn’t find it easily). What I did find was paper after paper noting that hepatitis A superinfection on top of hepatitis C is extremely nasty and, in fact, vaccination against hepatitis A is recommended for patients diagnosed with hepatitis C.

Kayser-Fleischer rings only occur in about 2/3 of patient with Wilson’s Disease, so a normal cornea does not rule out the disease (especially for someone who thinks 15% cure versus 85% death is an acceptable rate).

Hepatitis C treatment with interferon takes weeks (24-48). A few hours is way too soon to tell “it’s not working.”

Seven years of House’s weekly flagrant disregard of ethics and morals, and now we’re supposed to believe he is experiencing a moral dilemma over this patient – a political advisor? This writer has never watched the show before, right?

The medical mystery was rather pedestrian this week (rash and an itch? Oh, and liver failure). I give it a D, which is probably generous. The final solution of hepatitis C almost fits, but the hepatitis A superinfection scenario was far-fetched; I give it a weak C-. The medicine was, again, below average. Jumping from diagnosis to diagnosis without any underlying logic, and totally misinterpreting common symptoms: C-. The soap opera also underwhelming. Wilson seemed to show up just as a contractual obligation, there was no House/Cuddy chemistry, and the new team member is uninteresting at best (more frequently annoying). It also earns a C-.

The review of the previous episode of House
A list of all prior House reviews

This week’s House Challenge scores have been posted.

To Serve Man! It’s a cookbook!

Click on the image for the full ad

Actually, this is a fairly bland public service ad from 1961, towards the middle of DC’s PSA program. The message is good, albeit a bit vague (serve who, exactly), and Bernard Baily’s art, which is always very somber, looks downright depressing here.

This PSA can be found in most DC comics from August 1961. As mentioned, the art is by Bernard Baily, who did all the PSA art from 1959 to 1961, with writing by Jack Schiff, who wrote every ad from the DC’s PSA progam (1949-1967).

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Tags: comics psa serve jack schiff bernard baily

Another enjoyable episode of Fringe. It started out nice and creepy, but devolved into more of an espionage story — though the ending did redeem the story somewhat.

The Plot: A group of people who spend their evenings listen to mysterious “Number Stations” on their short wave radios hear something in the broadcast that gives them each a splitting headache, a seizure, and then complete amnesia. Naturally, the Fringe Team is called in to investigate. Walter confiscates a reel to reel tape containing the broadcast for him to evaluate. A short time later, the Team is called to a radio tower in Massachusetts where the mysterious broadcast was found to have originated. Inside, they find all the employees shot and a mysterious hovering box hooked into the radio equipment. The box is delivered to Walter’s lab for examination, but not before Broyles is able to pull a fingerprint off of it.

Back at the lab, Walter is able to discover a mysterious pulse that is being broadcast along with the numbers – his belief is that this pulse is what caused the amnesia. The fingerprint belongs to a man by the name of Joseph Feller. Coincidentally, at that very moment, Feller is hooking up one of his boxes in another radio tower. This time, twenty people develop amnesia, but another six die in a plane crash when a pilot accidentally tunes in to that station.

Looking through some notes at a victim’s house, Peter uncovers some information that indicates his friend the used-book dealer Markam has some knowledge of Number Stations. When questioned, Markam hands over an old book said to be about the First People — a race of man said to exist millions of years ago. The number stations are thought by some to be connected to them in some way. A quick perusal through the book does suggest the numbers and the First People are related.

Meanwhile, Fauxlivia meets up with Fuller and it becomes apparent that not only is he an agent of the alternate universe, but the amnesia pulse is masterminded by them. The pulse is not to hide the code, as originally surmised, but instead to draw the Fringe Team’s attention to it. When the rest of the Team closes in on Feller’s address, Fauxlivia stages a fight, shoots him, and then pushes him out a high window. She tells Peter that Feller attacked her and left no choice but to kill him. Her story is bolstered by the fact that Feller turns out to have been a shapeshifter.

Eventually, Astrid decodes the numbers and it turns out they lead to thirty eight locations around the world — and each of these locations holds a part of the machine Walternate has been trying to build.

1. What Luck!
It sure is convenient that these First People used a base-10 numeric system and the same latitude/longitude system we do (and not to mention that they speak Spanish and other modern languages).

2. Who Knew Astrid Had a Sense of Humor?”
Bach’s The Art of the Fugue is a bad pun. People with complete amnesia like the victims here are said to be in a fugue state.
Generally speaking, there are two forms of amnesia: retrograde and anterograde. In retrograde amnesia, the person forgets things leading up to the inciting event (be it physical trauma, psychological trauma, or a rogue radio station). In anterograde amnesia, things after the inciting event are forgotten. Both types can occur in the same patient.

3. “No ifs, ands, or buts”
It appears Walter was giving Becky the mini-mental status exam (better known as the “MMSE”)

4. Where’s Sportacus When You Need Him?
With that chin, Feller is a dead ringer for Robbie Rotten from LazyTown.

5. All the Archaeologists in the Audience Spontaneously Died of Heart Attacks
Is heavy machinery really the best way to dig for a priceless millions-of-years old artifact?

6. It is Veteran’s Day After All
What exactly is a military grade transistor? And why use a Polish one? That’s a dead giveaway something is up?
And can you really not do electronics in gloves? Seems unlikely to me. And even if it’s true, why not wear gloves when closing the case?

This was a solid episode of Fringe. Personally, I would have liked it better if hadn’t turned out to be alternate universe related. Still, I give them credit for using a real world phenomenon — the Number Stations — and running with it. The Doomsday Clock stays at 11:55.

This week’s Fringe cipher was: DECAY.
A list of all previous Fringe reviews is available here.
Karl, as always, has much more to say.

Tags: television fringe radio amnesia number stations fauxlivia

scene from X-Man Annual #2.

Nate Grey uses his telekinetic powers to contain a plague released by the evil scientist Sugarman in this scene from X-Man Annual ‘96 (by Terry Kavanagh and Alan Davis). For his efforts, he gets both a psychic nosebleed and earbleed.

(You may remember that a similar thing happened when his alernate reality self, Cable, tried the same trick — though this story predates it by several years).

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed nate grey x-man plague

Another low scoring week for the most part. No one guessed rickettsialpox, but two players had suggested kidney cancer, so that was worth some points.

This week, Ashtur and EJ both earned the high score with 12 points, followed by Paul S with 6 points and Forny with 4 points.

Overall, Gary retains the lead with 31 points. Tippi drops to second with 28 points. Sapramiska moves into third with 26 points. Jock M and atg are tied for fourth with 25 points. If your score is 18 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

The possibility of a smallpox infection was clever, and the medicine was mostly well-done on this week’s House, but the final diagnosis was contradictory and impossible

In 1793, a Dutch slave ship was purposefully sunk off the coast of Bermuda over fears that the cargo and crew were infected with smallpox. Two hundred and seventeen years later, Julies, a sixteen year-old diving on the wreck, brings an old glass jar to the surface. The jar breaks, lacerating her hand, exposing her to the contents of the jar: old scabs. Julie is eventually admitted to House’s service at Princeton-Plainsboro with symptoms of fever, vomiting, and bloodshot eyes. House suspects she has smallpox, so both she and her family are placed in isolation while tests are run. The rest of the team isn’t so sure she has smallpox, suggesting varicella (the virus that causes chicken pox and shingles) or measles as a possibility. Tests are run looking for the three diseases while the family is given smallpox vaccination.

The tests are all negative, but House continues to suspect Julie has smallpox. He hypothesizes that the pressure exposure from her scuba diving has driven the antibodies into her joints, so he has the team drain fluid from her joints to run more tests. While performing the tests, Taub notices a suspicious rash that looks like smallpox alongside Julie’s right knee. A close examination shows no hemorrhagic lesions (which would be a sign of hemorrhagic smallpox, a particularly nasty kind), but a petechial rash is in her right armpit that doesn’t fit the smallpox picture. To House, this new rash means that she does not have smallpox. Meanwhile, the Center for Disease Control (CDC) team this arrives to take over the case and lock down the hospital. The CDC arranges for DNA tests to be run that will confirm or dismiss smallpox once and for all, but it will take eighteen hours to get results. Chase finally arrives and suggests molluscum contagiosum as a possible culprit (sorry, doesn’t match the rash or explain the flu-like symptoms). House still believes it is not smallpox, but he needs proof and the CDC won’t allow him access to the patients. He manages to get a hold of a copy of the captain’s log from the slave ship and pays a Dutch internet stripper to translate it for him. According to the log, only the slaves got sick, not the crew. Given this information, the team proposes a differential diagnosis that includes sickle cell disease, vitamin D deficiency leading to immune suppression with subsequent infection with malaria or dengue fever, or scrofula (an older name tuberculosis infection of the lymph nodes in the neck). House wants to run a TB test, but knows the CDC won’t let him, so he has Foreman pretend he thinks it is meningococcus so he can run the test. As Foreman is trying to smooth talk the CDC doctor, Julie’s step-father develops a severe headache, red eyes, and a nosebleed. This is consistent with smallpox — but according to House it could also represent a brain bleed caused by the tuberculosis. M³ smooth talks the CDC doctors into running a head CT on dad to look for a bleed, but they notice a pustular rash on him and cancel the test since this is consistent with a worsening case of smallpox.

As the day goes on, both Julie and her step-father are worsening. There vital signs are worsening and the rash is spreading. M³ notices that Julie does not have the rash on her soles, while someone with smallpox should. Step-dad does have the rash on his soles — but he also has a history of kidney cancer. House now surmises that the step-father does not have smallpox, but instead disseminated vaccinia — an infection caused by the virus used in the smallpox vaccine (a virus similar to smallpox, but not actually smallpox). It has affected him so severely because his kidney cancer has returned and suppressed his immune system. As proof, House points to the bloody urine at his bedside as proof that his kidney failure (and yes, he said “kidney failure”) was caused by renal cancer and not smallpox. (House does acknowledge, and then promptly ignore, that this none of this explains Julie’s case). House enters the isolation room and injects the step-father with interferon, which should make him better, proving House right. Because he broke quarantine, House finds himself locked in with the patient, likely exposed to whatever the infection is. Unfortunately, the step-father doesn’t get better and actually gets worse. A couple of hours later, after a tearful talk with his wife and son, he dies. It seems we’re back to the diagnosis of smallpox. However, M³ is not ready to admit defeat yet. She has more of the captain’s log translated and discovers that the ship’s cat succumbed to the disease as well — which means it can’t be smallpox as that infects only humans. Hearing that the cat lost all its fur before dying leads her to suspect rickettsialpox, a bacterial disease transmitted by infected mites that live on mice. She has House check the step-father’s corpse for the tell-take eschar (scar) of rickettsialpox, and he finds one. A course of the antibiotic doxycycline and Julie should be as good as new.

As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

The biggest problem with tonight’s episode is that there’s no way the step-father could have caught rickettsialpox. Even if you accept that the bacteria could live hundreds of years in a glass jar at the bottom of the ocean and could infect someone who got old scab tissue in their blood stream (which seems very questionable to me), Julie could not have passed it on to her step-father as it is not transmitted person to person. Rickettsial pox is only transmitted from the bite of a mite infected with a certain bacteria (and it is this bite that leaves the eschar.) In other words, even if you accept the increasingly ludicrous ideas that 1) Julie caught the infection from the old tissue in the jar, and 2) somehow passed it on to her step-father, even then he couldn’t have had the eschar that proved the case as he was never bitten by an infected mite.

Sigh. Once again, you don’t shock a flatline.

The time course is wrong for smallpox (not a surprise as they commonly shorten time courses on this show, but still worth mentioning). Julie would not have started shedding the virus until the rash appeared (at least ten days after exposure), so her step-father shouldn’t have started showing smallpox symptoms until ten or more days after that.

Again, bloody urine does not equal kidney failure. (House’s point about the color was that a brown color meant the bleeding was before the kidneys filtered the blood, whereas a bright red color meant that the bleeding occurred in the kidneys).

Interferon has been shown, at least in animal models, to treat vaccinia. But it is not a single shot treatment — just like last week it takes several doses to have an effect. It’s not the first line treatment for disseminated vaccinia either, VIG (varicella immune globulin) still is.

The characters were confusing vesicles and pustules. Smallpox has both, but the terms aren’t interchangeable.

What sort of TB test did House want to run? Was he planning on having Foreman place a PPD, which takes 48-72 hours to get a result?

Step-Dad has kidney cancer severe enough to cause immune deficiency, but no other symptoms (except maybe the bloody urine?)

I know Step-Dad was (allegedly) immune compromised, but that was still awfully fast for step-dad to die. First signs of infection to death in less than 18 hours?

The medical mystery was intriguing this week. I like the idea of a smallpox, and the potential route exposure was not impossible (Civil War era smallpox scabs were discovered in an envelope hidden in a book several years ago). I give it an A-. The final solution of rickettsialpox was, for reasons I outlined above, impossible. It score an F. The medicine was fairly well done throughout, though the team never got a good exam on the patient which would have answered a lot of questions (for a legitimate reason this week). I give the overall medical aspect a B-. The soap opera was better this week: more Wilson, better House/Cuddy, and M³ was actually an enjoyable character — if only she had been written this way last week. I give the soap opera a B.

The review of the previous episode of House
A list of all prior House reviews

This week’s House Challenge scores have been posted.

A common plot device in DC’s public service ads was the DRIBALAD, i.e. the “Dramatic Realization I’ve Been Acting Like A D*ck.”

Here’s how it goes:
1. The characters do something thoughtless or cruel, but blow it off.
2. The same thing happens to them.
3. Suddenly, they realize the error of their ways and go back to correct their bad behavior and vow to never do it again.

The “Act Your Age” PSA posted a few weeks ago is a good example of a DRIBALAD. This week’s PSA is another great example.

Click on the image for the full ad

This PSA can be found in DC comics from June 1964. The script is — like always — by Jack Schiff with the art by Sheldon Moldoff.

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Tags: comics psa dribalad trash jack schiff sheldon moldoff

What’s wrong with this panel from the “original” graphic novel Superman: Earth One by J. Michael Straczynski and Shane Davis?

Two potentially very good storylines were combined into one not-as-good storyline in this week’s Fringe. And the science — don’t even mention it!

The Plot: An old man shaves his hair off, and then ritually anoints himself while repeating a religious liturgy. A little while later, a young boy is scared that there might be a monster in his closet. His mother comes in to reassure him, but shortly after she leaves, a man in a metallic mask — the same old man from the first scene — comes out of the closet, grabs the boy, and hightails it out the window. The Fringe Team is called in because thanks to the Peter Bishop Act of 1991, all kidnappings are assigned to the Fringe Team. Looking over some fingerprints discovered in the closet, Agent Lincoln detects that there is sugar in the prints – in other words, the perpetrator is secreting sugar. This means that the serial kidnapper, the Candyman, is back.

Every two years the Candyman appears and abducts a child and holds them for forty-eight hours. The children return with strange scars on the back of their neck and severe organ and immune system damage — as if they’ve been prematurely aged. Four years ago, Agent Broyle’s son Christopher was a victim of the Candyman.

Looking over the case files and recalling her own history (though it was her history in our world), Agent Dunham tells Lincoln that she suspects fluid from the pituitary gland is being siphoned from these children. Lincoln admits that it is theoretically possible, and the resulting high blood sugar in the Candyman may explain why he is secreting sugar.

Dunham interviews Christopher and learns that he overhead some of the liturgical chant used by his kidnapper. The Fringe Team is able to connect that chant to a small church in Astoria. They talk to the head of the church and receive a list of the church’s male members. The team splits up to interview everyone on the list. On one of her interviews, Dunham quickly realizes that she is talking to the kidnapper. After a brief gunfight, rescues the abducted child before any permanent damage has occurred. Looking through the kidnapper’s apartment, the Fringe Team discovers Dunham was right about him harvesting pituitary fluid. Belatedly, Dunham realizes that the kidnapper couldn’t have been working alone and deduces that the head of the church, a former doctor, must also be involved. At that moment, the doctor has broken into Broyles house in an attempt to kill Christopher, who he believes can identify him. Broyles and Dunham arrive in the nick of time to save his son and kill the doctor.

Dunham now plans, with help from taxi driver Henry, to return to the scientific installation on Liberty Island and try to return to our world. Broyles lets her know that he knows that she knows who she really is, and then he lets her go. Dunham makes it to the island and starts up the sensory deprivation tank. She successfully travels back to our world, but before she can escape the souvenir shop, she is yanked back to the alternate universe by Walternate and his security guards. All is not lost: she is able to get a message passed to Peter, a message stating she is still trapped in the alternate universe.

1. Swollen Glands
The pituitary is small gland located at the base of the brain. It releases over a dozen important hormones including TSH, prolactin, ACTH, Growth hormone, LH, FSH, oxytocin, and others.
Excesses of any of these hormones can cause symptoms, and these symptoms can include the tremors and hyperglycemia mentioned on the show. However, this collection of symptoms would require high levels of multiple hormones, and there would be a great many other readily identifiable symptoms. Basically, these patients would have both Cushing’s syndrome and hyperthyroidism.
The anemia is not so easily explained.

2. Rear Access
As mentioned above, the pituitary gland is located at the base of the brain, just behind the nose. In fact, when surgeons operate on the pituitary, they go in through the nose. Going in through the back of the skull/top of the neck is probably the worst place to access the pituitary because not only is the distance great, you have to cut through the brainstem to reach it.

3. Sugar, Sugar
We have a term for people with significant hyperglycemia — we call them diabetics. There is some evidence that diabetics have increased sugar in their sweat, but even if you accept that, there’s still a big problem with the Candyman: they’re confusing completely different sugars. Blood sugar is glucose, a simple sugar. Table sugar, sucrose, is a more complex disacchyride (a double sugar). While it contains glucose, it is not glucose. Sucrose is also not made by the human body. I don’t care how high a blood sugar someone has, they are never going to secrete sucrose.

4. “Those who are clever, who have a Brain, never understand anything.”
Max’s is not the only Burlap Bear fan. Olivia’s niece was reading the same book in Episode 16, Season 1 (Unleashed)

5. Alternotes
Newly mentioned differences between the two universes:
Three political parties.
Bird flu epidemic.
No FBI for ten years.

6. Gratuitous Product Placements
Ford Flex
Red Vines
Android phones

Candyman would have made a good full episode. Escaping back to Liberty Island would have made a good full episode. Combining them lessened them both. (Confusing sucrose and glucose was just icing on the cake, so to speak). The Doomsday Clock ticks another minute closer to midnight: 11:56PM.

This week’s Fringe cipher was: ESCAPE.
A list of all previous Fringe reviews is available here.
Karl, as always, has much more to say.

Tags: television fringe pituitary hyperglycemia candyman

No one guessed the final solution exactly right, but at least a bunch of people (including me) got partial credit for “multiple sclerosis.”

This week, EverybodyLies, Gleb, Jamie Pt., and Kirsten earned the high score with 7 point.

Overall, Tippi takes the lead with 32 points. Gary slips to second with 31 points. Jock M and atg are tied for third with 29 points. Corien and Fran are tied for fifth with 28 points. If your score is 21 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

This week’s episode of House hit viewers pretty hard over the head with the themes of trust and faith, and once more went to the atheist House versus believer storyline.

Ramon is struggling, carrying a heavy cross on his back up a hill. Once he reaches the top of the hill, his friends tie him to the cross and then nail his hands to the cross as well. As soon as he is secured, the cross is raised into position, but almost immediately, he begins to cough up blood so his friends bring to the hospital for evaluation. He is admitted to House’s service for hemoptysis (coughing up blood) and fever. As for the crucifixion, he explains that his daughter was diagnosed with terminal cancer a few years before, and he made a deal with God, that if He would save his daughter’s life, Ramon would crucify himself every year. The cancer disappeared, and so Ramon now keeps his end of the bargain with an annual crucifixion.

The team presents no initial differential diagnosis, but they seem to be performing a thorough infection screening since they mention needing to perform an LP (a lumbar puncture; spinal tap). In the lab, all their tests (including Toxocara, bacteroides, and Ascaris) are all negative. Taub suggests that Ramon may have picked up Rhodococcus equi at work (R. equi is a bacteria that normally infects horses, but it can infect immune compromised humans as well. It’s symptoms are similar to tuberculosis). When they explain this to the patient, he shows them that his teeth are falling out, which doesn’t fit Taub’s diagnosis. Now the team considers radiation sickness, Kaposi’s sarcoma, and heavy metal poisoning. The latter seems the best fit, so Foreman and M³ head off to Ramon’s apartment to look for a source of heavy metal. No heavy metal is found, but they find that Ramon has been subsisting on little more than beans and suspect that he is malnourished (which caused the tooth loss) and this left him susceptible to the Rhodococcus (which explains his other symptoms).

The solution’s not that simple of course. While talking to M³, Ramon mentions that his legs are causing him severe pain — yet he is grinning widely the entire time. Foreman diagnoses him with pseudobulbar affect — his face is displaying a different emotion than he is actually feeling. House suspects something neurological is causing the problems — and he considers Ramon’s unshakable faith in God as another symptom of his neurological problems. An MRI of the brain shows multiple lesions consistent with multiple sclerosis. He is started on Prednisone, but his symptoms worsen. His right arm becomes paralyzed (and numb) so House suspects he has a particularly severe and fast acting form of multiple sclerosis, Marburg variant multiple sclerosis. According to House, the only treatment with any chance of success utilizes embryonic stem cells, which he knows Ramon will reject due to his religious principles. Sure enough, Ramon refuses the treatment. The team brings his daughter in to talk to him, but he still refuses treatment. Finally House shows Ramon a PET scan showing that his daughter’s cancer has returned, thus proving that God has “broken his deal” with Ramon. Finally relenting, Ramon agrees to the treatment and shows rapid recovery. House then tells him the truth: his daughter’s cancer never returned — he showed him someone else’s PET scan. Despite House’s ploy and the fact that his symptoms are improving even when he broke faith, Ramon’s trust in God remains unshaken as the episode ends.

I had no really big medical complaints this week. Most of my comments fall into what I consider moderate/minor or nitpicking. Sure, the team was picking some wildly inappropriate diagnoses (Karposi’s sarcoma, really?), but they always do that. By my count, this is at least the third time the writers have gone to the House vs God well — enough’s enough.

As usual, major complaints are in red (none this week), more minor complaints are in blue, and nit-picking ones in green:

So Ramon was malnourished enough to drastically weaken his immune system, but not malnourished so badly that 24-36 hours of hospital food wouldn’t fix it (and what about refeeding syndrome). And the only symptom of this severe malnutrition/scurvy was a single lost tooth? And despite his malnutrition he was still able to lug a heavy cross up a hill?

Pseudobulbar affect is not a constant condition. It occurs in brief episodes of uncontrollable and inappropriate laughing or crying – not the persistent smile shown by Ramon.
They never mentioned common causes of hemoptysis and fever (like pneumonia, tuberculosis, or lung cancer), so I’m guessing they ruled them out off camera. Or are incompetent but lucky.
A lumbar puncture — for fever and a bloody cough?

There are other treatment for Marburg multiple sclerosis that show promise including Mitoxantrone and Alemtuzumab.

I’m interested in how long Ramon was crucified every year. It’s not simply a matter of damage to the hands from the nails, crucifixion is a nasty way to die and is decidedly unfriendly to the lungs and other thoracic organs.

Unless I’m mistaken (and I certainly may be), the team is talking about using embryological stem cells for a bone marrow transplant. BMT is a complex procedure and not as simple as just injecting the cells and being done with it.

FINAL THOUGHT: There were three final diagnoses this week? Malnutrition (lost tooth, immune suppression), rhodococcus (hemoptysis, fever), and Marburg MS (all the neurological symptoms that appeared while he was in the hospital).

The medical mystery was averagethis week. Hemoptysis and fever are nothing we haven’t seen many times before on the show. I give the mystery a C. The final solution — all three of them — actually fit pretty well and earn a B+. The medicine, though skimpy, was better than usual and earns a B. The soap opera and its theme of trust was what the show was about this week, not medicine. It was done well, and earns a B+ (except Chase, who earns an A).

The review of the previous episode of House
A list of all prior House reviews

This week’s House Challenge scores have been posted.

Another public service ad dealing with the United Nations, a very common theme of DC’s PSAs. Precisely as the name suggests, this ad showcases gifts given to the UN, because — after all — international politics is nothing but a big popularity contest.

Click on the image for the full ad

I don’t have much to add this week, except to mention that of the three countries mentioned in the PSA, one no longer exists.

Also, for a frame of reference, there are now 192 member nations of the UN — more than twice the number when this PSA was written (though admittedly, the UN was only 11 years old when this PSA was published).

This PSA can be found in DC comics from December 1956. The script was by Jack Schiff and the photography-inspired art was by Ruben Moreira.

As an added bonus, here’s a nice Thanksgiving-themed (well, sorta) PSA: A Salute to Our American Indians!

More PSAs

Tags: comics psa united nations gifts jack schiff ruben moreira/a>

Loonie Tunes and Merrie Melodies Comics #26

In this one panel from Batman #88, we get three of the classic comic book medical cliches:
1. A head mirror (worn incorrectly in the middle of his forehead).
2. An inappropriate blood transfusion.
3. A doctor able to make oddly specific predictions based on no evidence.

Detective Comics#871 “The Black Mirror, part one”
Scott Snyder, writer
Jock, artist

Detective Comics has been good this year for nascent mad scientists and those who have chemistry sets at home. First, the comic gave us the recipe (or at least part of it) for Joker Venom, as well as its cheap knockoff. Now in this month’s issue, we learn what it takes to control people like Jervis Tetch, the Mad Hatter.

The scene starts with Batman talking to Commissioner Gordon on the roof of the GCPD. First Batman discussed the Mad Hatter’s techniques:

To understand what Batman is talking about, it helps to understand a little about the class of drugs known as benzodiazepines. When explaining these drugs to patients, I’ve found it works well if I describe them as “the Valium class of drugs.” Benzodiazepines are commonly used as sedatives and hypnotics. They work well for treating anxiety — there is little better for quickly stopping a panic attack. Benzodiazepines are also used as muscle relaxants and as a treatment — especially an emergency treatment — for seizures.

Unfortunately, benzodiazepines have a strong potential for misuse, dependency, and addiction. They can also have particularly nasty withdrawal symptoms.

There are over two dozen different benzodiazepines. The most common, in the US at least, are diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax), and midazolam (Versed). [I suspect this list will result in some interesting comment spam.]

Note that the term “hypnotic” has nothing to do with hypnosis or mind control, but instead refers to Hypnos, the Greek god of sleep. Hypnotics are drugs that put patients to sleep.

Flunitrazepam is a benzodiazepine better known by the brand name Rohypnol. It is used primarily as a quick acting sleeping agent. It lingers in the system for quite a while, so can give patients grogginess and unsteadiness persisting into the next day. Rohypnol has a reputation as date rape drug, though studies have shown few actual uses in such scenarios. Flunitrazepam is not a designer drug.

Nilium is simply another brand name for Flunitrazepam — so it’s the same drug. (It would be like saying you took both Motrin and ibuprofen for a back ache — they’re the same drug!)

Next Batman disses a similar, yet apparently cut-rate, patch found on a victim:

Bear in mind that drugs he mentioned first, Flunitrazepam and Nilium (in reality the same drug), are also “benzodiazepine derivatives.” So Batman is essentially dismissing his own initial comments.

In reality, no benzodiazepine can brainwash or reprogram someone, no matter how nuanced the user. It can knock someone out — and probably make their memory a little hazy about what happened — but no mind control. Sorry, all you at-home mad scientists.

Thanks to reader T. Eliot for asking for my thoughts about this scene.

A head-on collision of two common public service ad themes this week, as “Superman carts kids around” runs headlong into “libraries are great!”

Click on the image for the full ad

Superman must have some incredibly long arms to hold four kids like that tight enough to ensure no one falls (or maybe he started out with six kids, and two slipped along the way).

I never liked the Superman pose in panel three — I know it’s common throughout the Silver Age — but it never looked realistic to me (especially when it looks cut-and-paste, like here). And yes, I’m aware that invoking the word “realistic” when discussing a Superman comic is just inviting trouble.

So Superman flies off in the third panel, only to return thirty seconds later in the fifth panel?

This PSA can be found in DC comics from May 1956. This particular copy was scanned in from Action Comics #216. The script was by Jack Schiff with art by Win Mortimer.

More PSAs

Tags: comics psa library superman jack schiff win mortimer

Things I’ve learned from Action Comics #216:

1. Despite what their brochures claim, Space Safaris do not make good vacations.
2. Radium makes you glow¹
3. As long as you keep moving, radiation can’t hurt you². Why did you stop to read this? Keep moving! For God’s sake, keep running!! Do you want to die? Don’t let the radiation catch you!