Polite Dissent

A reckless pharmaceutical researcher has developed an ultrapotent antihistamine. He wants to speed up FDA approval, so he decides to start human testing right away — but only on one test subject. The victim subject is injected with the drug and instantly keels over, dead. Or is he? A short time later, the plant-human hybrid Goldenrod appears, hunting down the researcher and killing him by allergy-ing him to death.

There is so much wrong in this story that it hurts my head to think about it. FDA approval works nothing like that; everything the researcher did actually made the FDA more likely to turn him down. Even if his plan works perfectly, he has nothing to gain from it, other than prison time. Even an amoral scientist running an illegal drug trial knows it takes more than a single subject. Why would an antihistamine turn someone into a plant? Did they really think Goldenrod was an good name for a villain?

Despite all this bounty to work with, what I want to focus on is the name they gave the antihistamine: Nuevafed.

A brand name like Nuevafed is not selected until after the drug is approved for sale, and even then the final name is in the hands of specially trained medical marketers (who, you’ll notice, seem to be inordinately fond of the letters Z and X). At this point in the story, the drug would be called by its generic name, which, because it’s an antihistamine, should end in -ine (e.g. cetirizine [Zyrtec], loratadine [Claritin], or diphenhydramine [Benadryl].)

I can’t think of any other drug sold in the U.S. that has Spanish prefix in its name. There’s some Latin inspired names (Paxil, for instance), but I can’t name a single one with a Spanish (or French, or Italian, or German, or Swahili, etc) name.

The “fed” suffix is used for drugs that contain decongestants (such as Sudafed and Actifed) because it is short for pseudoephedrine, a common decongestant (admittedly, since the crack down on pseudoephedrine a few years ago, you’ll now find phenylephrine in most of these meds instead, but it’s still a decongestant). A pure antihistamine, even a potent one like Nuevafed, wouldn’t contain any decongestant.

Last thought: If your antihistamine is actually “hyperallergenic” then you’re doing it wrong.

Avengers Academy #14 “Disaster Response”
Christos Gage, writer
Sean Chen, penciller

Small electrical currents directed through the heart can cause ventricular fibrillation, a dangerous heart arrhythmia that can quickly degenerate into a fatal rhythm.

As suggested in the scene above, larger electrical currents can damage the heart enough to completely stop it. Throw even more current at the heart and you’ll fry it (which, admittedly, would be a subset of “stopping the heart”).

It’s not just the heart which is susceptible to electrical shocks, but the entire body –- especially the brain and muscles because they are organs that, like the heart, rely on electrical current to function.

This panel also offers a nice reminder of why “you don’t shock a flatline.” In a nutshell, a defibrillator works by — just for a split second — stopping the heart, allowing a healthy rhythm to reassert control. You don’t shock a flatline because there’s no benefit to stopping an already stopped heart.

Invincible Iron Man #503 “Fix Me, part 3: Fear Itself”
Matt Fraction, writer
Salvador Larroca, penciler

Pepper Potts needs to find a better doctor for her employees:

I’ve heard this statement time and time again, and I’m regularly asked about it, so let me put it simply: wrong, wrong, wrong.

This advice generally comes in one of two forms, either “don’t let someone with concussion fall asleep” or “wake-up a patient who suffered a concussion periodically to check on them.”

The first advice is just plain wrong. To put it bluntly, someone who has suffered a concussion has had a bad day. They’ve been in a car crash, played a losing game of football, been beat up, fallen off something, or had some other sort of accident. They’re going to be cranky and they’re going to be in pain. The last thing they need to be is kept awake because it will only make the pain and the crankiness worse. Study after study has shown that sleep is good for healing, particularly healing from head injuries. Let the poor patient sleep!

The second bit of advice is a bit harder to pin down. There have been a few studies done and they showed no benefit from repeatedly waking the patient up to check on them, but they didn’t show any harm in the practice either. I can’t claim to be innocent in this regard: when I was a resident on my Neuro ICU rotation, I regularly wrote orders for “neuro checks every 4 hours,” though more out of habit and tradition than any particular concern. Today, I don’t recommend regular waking and neurological checks to my patients with concussions because I think they’ll heal faster (and certainly be less cranky) if they can get a good night’s sleep¹.

As a rule of thumb, I’d say that if a patient is examined by their primary care doctor or an ER doctor after a head injury and admitted to the hospital for observation, then waking them up to check on them at regular intervals is reasonable. On the other hand, if a doctor has examined the patient and sent them home, then there is no need for repeatedly waking up the patient — let them sleep!²

Notes:
1. My practice is almost entirely outpatient these days, so I don’t tend to see the more severely injured patients. If I did see one in the hospital, then I might order regular checks depending on the situation. Bottom line: if the patient is healthy enough to be released from the hospital, then they’re healthy enough to get a good night’s sleep.

2. If I have a patient with overly anxious parents, then I would assent to them waking up the patient for a quick neuro check now and then. There are some fights you just can’t win, and overly anxious parents are behind most of them. Remember, no harm is done by the practice (other than poor sleep), it’s just that no benefit is gained either.

UPDATE/FINAL THOUGHT: I should have made this point clearer: Up until about 10-15 years ago, “wake-them-up-to-check-on-them” was the advice commonly given by doctors in regards to all head injury patients. Your parents weren’t just doing it to be mean. But then doctors started looking at the situation scientifically, and not just as a matter of tradition. At this point, it was determined there were no clear benefits to waking up patients, and it was also realized that sleep is very important for healing. Over the next several years, the advice began to change, pushing for more sleep and less — if any — checking. Of course, as in most things medical, especially where “tradition” is concerned, some doctors are more resistant to change than others. Though well intentioned, the advice is outdated — and the advice given to Pepper Potts is even more outdated (you’d think Stark Industries would use more cutting edge physicians).

Amazing Spider-Man #661 “The Substitute, Part One”
Christos Gage, writer
Reilly Brown, penciller

Isoflurane is an inhaled anesthetic used for both induction of anesthesia (knocking patients out) and maintenance of anesthesia (keeping them out). It also works as an analgesic (pain killer) and a bronchodilator (opens up constricted airways — useful for people with asthma).

The original inhaled anesthetics used in surgery were flammable and had the unfortunate tendency to cause explosions. Sure, the anesthesia was good, but does that really matter when the entire operating room in on fire? A new generation of non-flammable anesthetic were developed — this included isoflurane and its close relatives enflurane and halothane. Over the past several years, the use of isoflurane has been gradually phased out in favor of an even newer generation of anesthetics that have a faster onset, though it is still commonly used in veterinary medicine and many third-world nations (because the newer anesthetics are ungodly expensive).

While cleaning some boxes in the closet, I ran across a pair of autograph pages I obtained during my trip to the Chicago Comic-Con back in 1991 (twenty years ago, geez!).

Click on the image for a larger image. It’s large enough it may take a second click to expand to full-size.

While I recognize most of the autographs, there are a couple on this page (and more on the second page, which I’ll post tomorrow) that I can’t identify. I’m sure I knew who they were twenty years ago…

On this page, there’s Phil Foglio (well prior to Girl Genius; I think was during Xxxenophile, I was a fan of his from What’s New with Phil and Dixie?), Fabian Nicieza (during his run on the original New Warriors; that’s his version of Spedball), Kim Yale (one of the nicest people I’ve ever met at a convention), and Hillary Barta.

I’m not sure who the signature is beneath Foglio’s. Ah Ha! Figured it out! It’s John Ostrander, which makes sense since Kim Yale is on the same page. And I don’t know who sketched and signed Ghost Rider (though twenty years later, the gold metallic ink it’s written is still looking good, so two thumbs up for metallic ink).

This is the second of two old autograph pages from the 1991 Chicago Comic-Con I ran across while cleaning out some old boxes.

Click on the image for a larger image. It’s large enough it may take a second click to expand to full-size.

Once again I recognize most of the autographs, but there are several I don’t remember who they’re from

On this page, in the upper left is William (Bill) Reinhold, though I don’t remember who he’s sketched (Badger, maybe?). Beneath him is Danny Fingeroth. I don’t recognize the signature in the lower left.

In the right upper corner is another one I don’t recognize, but at least it’s made out to me. Beneath that is Ron Frenz, and he sketched Thor’s hammer as well. Under the hammer is another one I don’t remember. The autograph and sketch in the lower right are from the late, great Mark Gruenwald,

I know it’s summer time, and the last thing anyone wants to think about is studying — but tough — today’s public service ad teaches about study skills.

Click on the image for the full ad

Other than the fact that the kids are taking advice from a scruffy stranger at the local diner, there’s nothing really objectionable about this ad; the advice is quite reasonable.

I just wonder about the PSA-verse (is this one of DC’s 52 world multiverse? I hope so.) where it is perfectly acceptable to eavesdrop on anyone’s conversation and interject at anytime. Kidnapping of children by random superheroes is normal and accepted as well.

This PSA can be found in DC comics from both November 1965. The script is by Jack Schiff with art credited to Sheldon Moldoff.

More PSAs

Tags: comics psa schoolstudying jack schiff sheldon moldoff

Last day of vacation, sigh.

It’s been nice — lots of relaxing, reading, swimming, and eating. Tonight though, time to head back to the Midwest just in time for a heat wave.

Here’s what I’ve learned this vacation:
Strange Tales 130s-150s — does it get any better than this? The original — and still best — Nick Fury and SHIELD storylines, introducing among others Hydra and AIM. Also, some of the best Dr. Strange stories: Eternity, the Living Tribunal, Umar — just to name a few (though Zom was pretty stupid).

Extreme Justice — is there a more ’90s comic that this? First, the name: “Extreme.” The art is full of splash pages and mullets, and the artist is trying to channel Bart Sears’ version of Captain Atom without the skill to pull it off. Also, Monarch. Finally, easily some of the worst blocking I’ve ever seen in a comic — there’s a particular scene I’ll post tomorrow, once I’m home and have access to a scanner again.

scene from Fear Itself: Spider-Man #3 by Yost and McKone

Once again, you don’t shock a flatline (”Why?” you ask — I’ll make it simple: defibrillators are used to stop a dangerous heart rhythm; they cannot “jump start” a heart).

And what’s especially frustrating is this comic got it right just a few pages before.

Let’s not even talk about how this doctor is sharing the bad news (not too poorly, actually), or how accurate his information about leukemia is (greatly oversimplified), let’s just look at the horrendous blocking of this scene:

scene from Extreme Justice #0. Click to embiggen.

Panel 1
Outside view of doctor’s office

Panel 2
Doctor: Leaning against counter, reading long printout of labs
Ron Raymond: Sitting on exam table.

Panel 3
Doctor: The shadow obscuring the left half of his face has somehow turned his lab coat gray.

Panel 4
Doctor: Appears suddenly behind Ron. Lab coat is white again.

Panel 5
Doctor: Now he’s behind a desk; on top of which there is apparently a hobbit skull.

For the record, on the next page, the doctor remains behind the desk, though his lab coat flips between white and gray – maybe the room is lit like a bad disco? His top shirt buttons also are now undone — he opened them out of compassion, I suppose.

This is another in a long line of DC Comics public service ads telling kids how best to spend their summers.

According to their PSAs, it seems DC Comics didn’t want their readers just to fritter away their summers — they wanted them to work, or go to museums, help others, or spend their time (gasp!) reading. Even the light-hearted funny animals “Tips for Summer Fun” PSA exhorts kids to spend time at their library.

Click on the image for the full ad

Previous Summertime PSAs:
Tips on Summer Fun!
How to Spend a Summer Week!
Summer at Home Can Be Fun!

This PSA is one of the last ones from DC Comics PSA program and can be found in DC comics from July 1967. The script is by Jack Schiff with art by Sheldon Moldoff.

More PSAs

Tags: comics psa summerjack schiff sheldon moldoff

What’s the error in this scene from WildC.A.T.S. Annual #1? (On a scale of 1-10, with 1 being the easiest and 10 being the hardest, I rate this quiz a ½.)

Previous picture quizzes

A rare treat here, a doctor who knows how to wear a head mirror: it’s over an eye instead of in the center of the forehead, and the hinge is drawn correctly off-center.

On one hand, you’d think technologically advanced Thanagar wouldn’t need head mirrors — but then again, it’s clear we are dealing with the Thanagarian underclasses here. It still doesn’t explain why an Ob/Gyn doctor needs a head mirror, though.

Please Dr. Heath: a brain embolism is a stroke.

(Technically, a brain embolism is a type of stroke. Broadly speaking, there are two types of stroke: ischemic and hemorrhagic. In ischemic strokes, one of the blood vessels supplying the brain has been blocked. This blockage could be due to a clot formed in the brain [thrombus] or a clot or other blockage from elsewhere in the body that has traveled to the brain [embolism]. On the other hand, in hemorrhagic strokes, one of these blood vessels supplying the brain has started to bleed out. )

Ordering an MRI to determine which type of stroke is appropriate, since they’re treated in very different ways.

First of all, “a thousand gigawatts”? Why not just call it “terawatt”? (I know, a thousand gigawatts sounds bigger, but then why not go with “one million megawatts”?)

I’m not surprised that Maul’s brain is short circuited: a terawatt (oops, “one thousand gigawatts”) is a huge amount. In an entire year, mankind uses just under 16 terawatts of power. That means that Maul is being subjected to 1/16th of the world’s total energy consumption. Or to look at it another way, all the wattage produced by every nuclear reactor in the world is now flowing through him. Ouch.

That’s one hell of a taser.

Or if you prefer a more Hollywood explanation, one terawatt would provide Marty McFly and Doc Brown 826 trips in their Delorean.

New Avengers #11
Brian Michael Bendis, writer
Mike Deodato, penciler

Mockingbird has been badly injured and is rushed to the nearest emergency room. When she is found to be pulseless, she is shocked (defibrillated). Is this appropriate?

Shocking a patient without a pulse may be a good choice — it all depends on why they’re pulseless. Remember, the pulse is a finding on physical exam; it is not read from a monitor or display.

There are many reasons a patient could not have a pulse:

1. They could have an abnormal heart rhythm, such as atrial fibrillation or ventricular fibrillation, which causes the heart to beat so fast there is not enough time for it to fill with blood and pump it throughout the body. In this situation, defibrillation is the correct treatment.

2. The patient could be in asystole (flatline) or PEA (pulseless electrical activity– some electrical activity in the heart, but not enough to cause the heart to beat.) These are signs of a dead or dying heart. Defibrillation is not appropriate.

3. The heart could be beating normally — or almost normally — but there is some systemic reason there is no pulse. For example, there could have been so much blood loss that not enough force can be produced to generate a pulse. Other reasons would include vascular damage from trauma, or abnormally hardened arteries that don’t transmit a pulse well. The treatment in this situation is to correct the systemic problem, and hopefully that will be enough.

4. Finally, you could have an incompetent doctor who can’t find the pulse. (Admittedly, trying to find a pulse in a crashing patient, let alone one with significant trauma, can be quite challenging). Treatment? Keep trying.

If Mockingbird falls into the first category, then defibrillating is a good choice. However, every sign points to her being in the second category, where shocking is not appropriate.

Her initial heart rate shows bradycardia (a slow rhythm) with no signs of fibrillation. If anything, it appears to be slowing down. It also make the official flatline sound of “beep beep beep beep beeeeeeee—“

The doctor reports that she has “no readable pulse.” As I mentioned earlier, you don’t read a pulse — you palpate (feel) it. This suggests he is looking at the heart monitor and reading the heart rate, not the pulse. A heart rate of zero is a flatline, and as I’ve discussed many times before, you don’t shock a flatline.

Final thoughts:
Kudos for at least acknowledging the need for an airway.
For a patient with a chest wound, they’re futzing with her abdomen an awful lot.

scene from Rom #2 (by Mantlo and Buscema)

Dr. Peters comes all the way out to the Clarks to make a house call — a rare thing, even back in 1980 — and gets all but called a quack by his ungrateful patient. Note that he never calls Brandy a liar or tells her she was imagining things¹, just that she has a case of shock. He may actually believe her: if she actually saw an alien robot shoot and kill townspeople, that in itself would be enough to cause “a mild case of shock.”

1. Admittedly, it is strongly implied.