Polite Dissent

Of bandaging the head over the costume?

scene from Daredevil #164 (by McKenzie, Miller, and Janson)

Birds of Prey #4 “Absolutely Mental”
Duane Swierczynski, writer
Jesus Saiz, penciler

Reading the otherwise excellent Birds of Prey #4, I ran across a common misconception about the AMA (the American Medical Association):

The American Medical Association is a no more than a professional organization of physicians — essentially a large powerful lobbying group. They are not a government agency and have no official sanction. The AMA has nothing to do with drugs, or side effects to drugs. They certainly have no power over patients taking drugs — even for unapproved purposes — so would be no concern to Black Canary. Additionally, the AMA has no authority over any doctor’s medical license — they cannot award them or suspend them (not an issue in this comic, but an even more common misconception about the AMA in general).

So this new “experimental stroke treatment drug” has an annoying mind control side effect? Who should handsome young Dr. Cahill report his concerns to? The FDA. They’re the ones in charge of approving (and in some cases, unapproving) drugs and keeping track of reports of side effects. The pharmaceutical company should also be tracking the side effects of their drugs, though recent reports have shown that they’re not always as enthusiastic about that as they should be.

Or this all could be a really lame pick-up attempt by Dr. Cahill.

Another post dealing with AMA misconceptions, the Beast, and Dr. Mid-Nite.

One of my favorite Christmas gifts this year was a reading copy of the relative obscure comic, Captain Nice #1. The comic, and the TV series it is based on, appealed to me the minute I discovered that it 1) features a pharmaceutically-enhanced super-hero (a particular interest of mine); and 2) stars William Daniels, probably better known — depending on your tastes — as Dr. Craig in St. Elsewhere, the voice of KITT in Knight Rider, or John Adams in 1776.

Never heard of Captain Nice? Well then, let me educate you.

A product of the era when camp was the name of the super-hero game (at least on TV), Captain Nice lasted half-a-season in 1967. The series featured Carter Nash, a quiet, overly-polite police chemist who still lived at home with his parents. One day, Carter discovered a foul tasting elixir that turned him into the super-hero “Captain Nice” when he drank it. Captain Nice had the standard assortment of super-powers: strength, invulnerability, and flight, but didn’t have the skill or experience to use them well — plus, he was scared of heights, which made flying a challenge. The series was mostly a slapstick style of humor and hasn’t aged all that well. There are some nice touches, though — I like the way he wears his glasses over his mask.

But why not decide for yourself? Thanks to the wonders of YouTube, 45 years after the show was broadcast, you can still get your chance to watch it, or at least one episode of it:

Though only fifteen episodes were produced, Captain Nice still lasted long enough to earn a comic series, if you count a single issue as a series. The front cover is a photo cover, and the inside front cover sports a few small black and white photos and a quick synopsis of the show: Carter Nash is the kind of son every red-blooded American mother wants, quiet, polite and obedient. And when there’s trouble in Bigtown, he’s a son to be proud of because he’s Captain Nice, enemy of the wicked, Champion of the Weak, Hero of The Month, Son of the Year! (Unusual capitalization in the original.)

Next comes four brief comic stories featuring the good Captain. First is Fowl Play, concerning a villain known as the Rooster that Captain Nice captures by fooling him into crowing at dawn. Second is The Big Flood, where Captain Nice tries, and fails miserably, to stop a dam from breaking and a town from flooding — but it ends up OK because the town’s citizens all wanted lakefront property. Third is a day-in-the-life story called Good Deed Indeed where every good deed the Captain performs ends up back firing. The final story is Think Mink, where Captain Nice pits his abilities against the cat burglar Slymme Fatale, and loses. In addition to the stories, there are a couple of generic humor pages, a PSA about bridges, and then photos from the show on the back cover.

The art is competent, but not outstanding. The main character barely looks like William Daniels, but that way, at least we don’t run into the same statted image of the actor showing up repeatedly like in the licensed Ben Casey comics. Again, I’ll let you decide for yourself as I’ve scanned in the third story in its entirety.

Reading this comic, I realized I had seen the fill-in humor pages before. The one about monsters I particularly recognize. I know I read it sometime when I was a kid, and I remember it well enough to know I must have owned the comic it was in, but I have no idea when I read it or in what comic. It must have been in a reprint or an old comic because I hadn’t been born when this comic came out. I looked it up on GCD, and I don’t recognize a single comic listed as containing the page in question. Damn, now I have to figure this out!

click to embiggen

I’m not going to beat around the bush here: this was a disappointing issue on many levels, and an underwhelming end to Hawk & Dove’s first storyline.

Using an imprisoned Deadman, Condor and Swan escape through a doorway to the “War Realms.”

Desperate to find Deadman (in Dove’s case) and Condor (in Hawk’s), the pair contact Madame Xanadu who sends them to Salem (Massachusetts, I presume, though maybe Oregon or Illinois) to squeeze the information out of a demon. What they learn leads them back to a theater in Washington DC that holds an entrance to the War Realms.

Once they enter the Realms, Hawk and Dove are confronted by a monstrous Condor who drones on once again about the War Circle and finding and killing all the Avatars of War. He shrugs off an attack by Hawk then goes after Dove, taunting her about the uselessness of an Avatar of Peace. He slices her across her belly with his claws, just like Swan did in issue three, and then, just like Swan, falls prey to the same golden light issuing forth from her wound. Bathed in this deus ex machina light, Condor dissolves away into nothingness, defeated. It’s not all happiness and sunshine for our heroes though, as Deadman decides this is the perfect moment to break up with Dove.

The art this issue is Rob Liefeld assisted by Marat Mychaels. There are a number of baffling artistic choices (many noted below), but overall, the art is no better or worse than last issue. Backgrounds are still a crapshoot with Liefeld, more often missing than present, and his understanding of anatomy and perspective remains unique.

On a scale of 1 to 5 deformed Captain Americas, with 1 being good and 5 being execrable, this art on this issue rates 4 deformed Captain Americas.

Five issues in, and we still haven’t learned more about what puzzled me back in issue #1. How much of the pre-NüDC history of Hawk and Dove still is relevant? Some of it clearly is, but much isn’t — and what is and isn’t seems to shift from issue to issue. Long running mysteries are all well and good in Batman or Superman, when you know the comic is going to be around for the long run to answer them, but let’s be honest: at this rate Hawk & Dove will be lucky to last a dozen issues and I’d rather not have them end up on the ever increasing pile of comic story arcs that will never be completed.

This series has too many important scenes happening off camera. This issue, it’s the death(?) of Swan and the meeting with Madame Xanadu.

Two pages of conversation without either party actually opening their mouths. Ventriloquist’s dummies speak more realistically than Hank and Dawn.

The mysterious War Realms are…a city rooftop and a city skyline? Shouldn’t they be, I don’t know, more war like?

For all Dawn’s professing of her love for Deadman, we sure haven’t seen it in the series to date. All the more important as the pair barely seem to tolerate each other is Justice League Dark. The mooning after Deadman doesn’t fit in with what we’ve seen of Dove before, and after, the Nü52 reboot.

A sideways two-page spread? We really are back in the ‘90s. But surely a waste of pages such as this must be an awesome scene, right? Wrong — just another page of Hawk and Dove leaping from building to building with yet another gratuitous (and anatomically improbable) butt shot of Dove.

The demon Hawk and Dove are chasing is wearing pants? I guess it gets cold in Salem and you don’t want to go commando. Notice how he isn’t wearing a shirt except for the once scene where Hawk has to grab him by one, then suddenly, there it is!

I will give bonus points for the Dark Crystal shout out — and from Hawk, no less.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove condor swan sterling gates rob liefeld

From his very first appearance, Daredevil has had the ability to tell if someone is lying by listening to their heartbeat. It’s a skill he’s used numerous times over the years, and continues to use to this very day. Other heroes, such as Supergirl, have demonstrated a similar aptitude (I don’t know if Daredevil was the first to show this skill – you’d have to ask Waid, Busiek or Shutt about that — but he’s certainly used it the most.)

But is it true? Does someone’s heartbeat speed up when they’re lying? Daredevil presents as a certainty (“I can hear his pulse rate. It’s speeding up, indicating he’s lying!”), but is it? I have my doubts.

Certainly there’s a grain of truth there. When someone is stressed — and lying is generally stressful — their heart rate will speed up. But the heart rate is a very non-specific sign, and there are many, many things that affect it, causing a faster or slower heart rate on a moment’s notice. For a lowlife thug, just seeing Daredevil and realizing he’s soon going to be receiving the beating of his life would be enough to cause his heart rate to skyrocket, no matter whether his answers to Daredevil’s questions were true or false. Or maybe the person has Wolff-Parkinson-White syndrome, or a similar condition which causes rapid heart rate. Or maybe he just took a decongestant, or used his asthma inhaler, or had too much caffeine at lunch. Or maybe he just saw a pretty girl walk by. The point is, there are too many things that can cause a sudden increase in the heart rate to know for sure if the person is lying.

There’s also the question of whether lying always raises the heart rate. I expect it usually does, at least in big lies — but what about little lies or white lies? When my kids ask about Santa and I assure them he will be coming down the chimney on Christmas Eve, does my heart rate rise? What if I’m an accomplished liar? Would a long time criminal like the Fixer actually care enough about “Battling Jack” Murdock for his pulse rate to rise when talking about his murder? I doubt it. Just like there are conditions and medications that can cause an elevated heart rate, there are similar causes of a slower than normal heart rate. How does Daredevil know the people he questions aren’t on beta-blockers or similar drugs that slow the heart rate and blunt any rise in the pulse?

Finally, remember that the polygraph — the “lie detector” — which is generally considered unreliable at actually determining whether someone is telling the truth or not, uses the heart rate as just one part of its lie detection. If the polygraph as a whole is unreliable, why would just one part of it be any more reliable?

(In other words, to believe that Daredevil could actually detect a lie, I’d need to be convinced of two things. First, that a liar’s pulse rate always increases when he’s lying. Second, that lying is the only thing that could account for the increased heart rate. Similarly, to believe that Daredevil could detect that someone was telling the truth, I’d need to be convinced that a liar’s pulse rate always increases when they lie, and that there’s nothing else that could explain away the normal heart rate. Don’t worry, I accept the rapid pulse = lying for the purposes of the story — just like I accept that people can fly and lift buses — I just don’t like the “science” behind it.)

However, after he’s been acquitted of the charges, Hogman admits to Murdock that he did indeed kill Flapper. How did he get this lie past Daredevil?
I’ll let him explain it:

Oops. How could Matt have missed that?

Actually, I can’t blame Matt for missing it, because it makes no medical sense.

Pacemakers only affect a slow heart rate — they do not affect a rapid heart rate. In other words, pacemakers are used to speed up a heart that is beating too slowly, or one that skips too many beats. They do not stop a heart rate from rising and would not have prevented Hogman’s heart rate from increasing when he lied on the stand. Matt should still have caught him in his lie.

(To be fair, Hogman could have an underlying heart condition such as sick sinus syndrome which causes his heart to be beat too slowly and not respond to stimuli — hence the need for a pacemaker — but that is not what is implied by this scene.)

Q: You need to x-ray Superman, but a normal x-ray won’t penetrate his Kryptonian skin. What technique should you utilize?

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A: You use a Super XXX-ray, of course!

A good episode of Fringe — one of the best of the season. It occurs to me that the “espionage” episodes of Fringe have been some of the best of the last two seasons, probably because — thanks to the shapeshifters — Fringe can pull of paranoia better than any other show.

The Plot: Peter Bishop has decided that he needs to get home to his universe, and in order to do so, he needs to recreate The Machine. He can’t do this without Walter’s help, but Walter still wants nothing to do with him. Peter heads over to talk with Olivia in an attempt to convince her to get Broyles let Peter cross the bridge over into the other universe and talk with Walternate. Instead, Olivia tells Peter where to find Walter’s original dimension-crossing device. She and Peter and Agent Lee take the device to the Orpheum theater — where Olivia’s cortexiphan team crossed over at the end of season two — and Peter and Lee cross over. The plan is for this Agent Lee to pretend to be that Agent Lee and bluff their way onto Liberty Island. The plan works at first, but Peter and Lee end up captured by Fauxlivia and otherLee. As they are being transported to Fringe HQ for questioning, an attempt is made on their life by one of the Fringe agents. Lee is ultimately recaptured, but Peter escapes.

Lee tells Fauxlivia and otherLee that his team suspects Walternate is behind the new shapeshifters. Since they have some concerns of their own, Fauxlivia and otherLee decide to check out his story.

Meanwhile, Peter has headed to Tarrytown, New York, where Walternate’s wife, his other-other-universe mother, lives. She recognizes who he is and gets him in to see Walternate. Peter and Walternate have a tense meeting where Peter accuses him of not only being unrepentantly evil, but also being behind the new shapeshifter attacks. All the while they’re talking, Walternate is building some sort of handheld weapon. Walternate calls his chief scientist Brandon in to vouch for him, then shoots Brandon in the face with his weapon. It turns out that Brandon had been replaced by a shapeshifter several weeks before and Walternate suspected. He asks Peter to cross back over and tell the other Fringe team that he is not behind the shapeshifters.

Across town, Fauxlivia and otherLee’s investigation has not confirmed Lee’s story, but hasn’t contradicted it either. They ask Broyles for more time to finish their investigation and he reluctantly agrees. Then, once they’re out of the room, he calls a third party to let them know Fauxlivia and otherLee will soon arrive. The person he calls? David Robert Jones, the main villain from way back in season one.

As the episode ends, a wounded Observer appears to Olivia. He warns her that in all the futures he’s seen, she has to die. Then, like Batman, he disappears.

1. Your Heart Is Full of Unwashed Socks
Just a few episodes after going out of his way to help the Fringe team with their shapeshifter problem, Peter’s suddenly become frighteningly cold. “Who care if two universes die, especially a universe where I have friends, as long as I get home?” That’s a rather abrupt change for Peter.

2. Cephalgia
Olivia still has the headache Nina’s covert treatment gave her at the end of the previous episode.

3. Into the Valley of Death / Rode the Six Hundred
Either otherLee was making a bad joke of an allusion, of 2. Cephalgia “>The Charge of the Light Brigade is quite different in the other universe.

4. Reichenbach Falls
The “bad guy” Peter was so non-chalant about cutting in half and killing? That’s the same David Robert Jones that Broyles was calling at the end of the show (and incidentally, he made a damn good Moriarty in the recent movie Sherlock Holmes: A Game of Shadows).

A good episode, even missing the monster-of-the-week (or maybe because of that). The Fringe Doomsday Clock retreats a minute to 11:5511:53

This week’s Fringe cipher was: JONES. (Make sure you say it like Belloq in Raiders of the Lost Ark: “Jones!”)
A list of all previous Fringe reviews is available here.
As always, Karl has more to say over at his blog.

Puerto Rico,
You lovely island
Island of tropical breezes
Always the pineapples growing
Always the coffee blossoms blowing

Click on the image for the full ad

Interesting how the PSA claims the citizens of Puerto Rico have full rights and privileges of U.S. citizens, right before enumerating which rights they don’t have.

Apparently people living on Hawaii lack certain rights as they are not “mainland” citizens. (For the record, this PSA was published several years after Hawaii became a state.)

Back when I was a doctor in the Air Force, about a hundred of us were returning to the States after a several month deployment to Haiti. We had an overnight stay in San Juan, Puerto Rico, before flying the rest of the way back to Nevada. As we were getting off the plane, one of the airmen asked if he needed to exchange his money for “Puerto Rican money.” I calmly reminded him that Puerto Rico was part of the United States and his regular money would be just fine. I may have rolled my eyes a bit, too — sources vary. Looking back, I missed a great opportunity: I should have taken his $20, told him I’d exchange it, and then given him back a $5 telling him it was local currency.

This PSA can be found in DC Comics from April 1963. The script, warts and all, was written by Jack Schiff with art bu Sheldon Moldoff.

More PSAs

Tags: comics psa puerto rico citizen jack schiff sheldon moldoff

I’m sure they weren’t the first villains to use fear inducing drugs, but the Scarecrow and Mr. Fear are undoubtedly the best known villains who make use of them. I thought I’d take a brief opportunity to look back and see when they first started using their concoctions.

Scarecrow’s first two appearances were in the Golden Age and, frankly, were not terribly imaginative or exciting. Jonathan Crane was little more than a thug (albeit an over-educated one) who used a scarecrow motif. The only fear he caused was by threatening and shooting victims with a run of the mill pistol. It wasn’t until the Scarecrow’s first Silver Age appearance in Batman #189 that his fear gas was seen, and even then it was fairly underwhelming and only seen in one panel. The gas was just one of several techniques used by Crane to instill fear in Batman and Robin.

scene from Batman #189 (by Gardner Fox and Sheldon Moldoff. February 1967)

Mr. Fear and his fear gas pellets appeared in Daredevil #6 and predated Scarecrow’s use of fear gas by two years. Zoltan Drago was slightly mad chemist who ran a failing wax museum. His brilliant plan was to devise a serum that would bring his wax figures to life, giving him an unstoppable army. Yet somehow, despite his genius, he was unable to get his experiments to work. Then one night, his cat jumped up on his work bench and spilled some of his chemicals onto a Bunsen burner. The smoke it gave off induced terror, and Drago decided to use his accidental discovery to become Mr. Fear.

scene from Daredevil #6 (by Stan Lee and Wally Wood. February 1965)

To the best of my knowledge, Demerol has never been considered a truth serum. That is a term usually reserved for certain barbituates (sodium pentothal, amobarbital) or anticholinergic drugs (scopolamine). Demerol (generic name meperidine or pithidine), on the other hand, is a very potent narcotic pain killer. Admittedly, unlike most narcotics, Demerol does have some anticholinergic effects, but these don’t kick in except in very high doses, and the poor victim would be unconsciousness and probably dead from a Demerol overdose long before the effects became clinically useful.

More Comic Book Truth Serums

The second cat-and-mouse Fringe episode in a row, and the second good one in a row. Coincidence?

The Plot: Fauxlivia and otherLee arrive at the warehouse they learned about at the end of last episode, and find David Robert Jones waiting for them inside. He makes a not-so-subtle threat by killing one of his own shapeshifters, and then surrenders himself to them and asks to be taken to their leader.

At Fringe HQ, Peter recognizes Jones as the man he thought he killed, and watches alternaBroyles’ interrogation of him. Peter even does a little interrogation of his own, a situation that seems to unnerve Jones, even though he doesn’t recognize Peter. Jones asks for a certain hard drive hidden by the shapeshifter Brandon, and when it does not arrive in time, kills an ER full of people. He then demands to be released or he will kill more innocents. Walternate agrees, and the team has just enough time to slip a tracker into Jones so he will be easy to follow. They track him to a crowed public plaza but it is clear he knows he is being watched. He grabs a package from a nearby trash bin containing a thermos and a stack of money. He starts handing out the money to passersby and drinks from the thermos. All the money has trackers identical to his, and the liquid in the thermos knocks out his tracker, so he is able to escape when dozens of extra subjects show up on Fringe’s trackers, but he no longer does.

Looking over the information contained on the hard drive Jones wanted, the Fringe team finds dozens of satellite geographical pictures. Peter realizes Jones is looking for Amphilicite, a rare but potentially very dangerous mineral. They determine one particular quarry is the most likely spot for the mineral so they race to beat Jones there. At first, they believe they’ve beaten him to the punch, but then they realize the satellite pictures are from our universe, not the alternate one. Jones has crossed over and is harvesting the mineral from our side. Peter and Agent Lee cross back to our universe and join the rest of the Fringe Team in trying to capture Jones. As usual, Jones is one stop ahead of the team and is able to escape back to the alternate universe with nearly a hundred pounds of the Amphilicite.

Meanwhile, Walternate’s wife Elizabeth has arrived in our universe to talk Walter into helping Peter, and ultimately, he agrees.

Walternate helms an emergency meeting between both Fringe teams as they realize they have to work together to stop Jones.

As the episode ends, Jones is communicating a secret partner about phase two of their plans, a phase that has to do with a certain unnamed “her.” The final shot of the episode reveals his partner to be Nina Sharp.

1. Bad Feng Shui
I’ve never known an Emergency Room with only one entrance. There are usually a half dozen or more. Strange and dangerous things can happen in ERs and you need lots of room for people to rush in, or out.

2. Spares, Just In Case
Are there just extra guns laying around in Fringe division vehicles?

3. Continui-what?
How many of the previous adventures have the various Fringe teams not experienced?
Nobody recognized Jones.
Walter’s comments about no sign of forgives makes me think he never received the eponymous white tulip.

4. Big Bang Dune
Mentat Astrid seemed less Mentat-like and more Sheldon like this episode.

5. What is the RDA of Amphilicite?
Has Amphilicite been mentioned in the show before? I can’t find any mention of it in my notes so I’m just wondering.

6. A Little Too Trusting
Once again, everyone is way too trusting knowing there are shapeshifters all around. Walternate is even suggesting that Fringe team is compromised, but doesn’t check if the person he’s telling is the real alternaBroyles (probably not, but I wouldn’t put it past the writers to try and pull a fast one).

Another good episode. As always, David Robert Jones makes an excellent villain. The Fringe Doomsday Clock retreats a minute to 11:52

This week’s Fringe cipher was: DEATH.
A list of all previous Fringe reviews is available here.
As always, Karl has more to say over at his blog.

This week, Hogan and jwsellers took first with 13 points. Nextsundayad, vivalavida, and wkmaier were close behind with 12 points.

Overall, James H and Nextsundayad share the lead with 39 points. wkmaier moves into second with 38 points while Dr. R drops to fourth with his 37 points. Yerkietand mbrigdan are tied for fifth with 35 points. If you have 31 or more points, then you are in the top 10%.

Click here to see the full scoreboard.

An unfortunately average episode of House where the most interesting question is left unanswered.

Andres is a man with early onset Alzheimer’s disease. He is being evaluated for possible inclusion in a drug study when he develops bloody vomiting. He is admitted to Princeton-Plainsboro Hospital and assigned to House’s service. The team’s initial thought is that the patient has a gastrointestinal bleed which is causing the bloody emesis. An EGD (upper endoscopy) is performed and it shows a Mallory-Weiss tear (a rip in the esophagus of those who vomit frequently or forcefully), but that is a consequence of vomiting, not a cause. Andres is also noted to have elevated liver enzymes, and the diagnoses of gallbladder disease and steatohepatitis (fatty liver) are mentioned. House favors the latter and decides to start the patient on statins (a class of cholesterol drug as high cholesterol is almost always seen with steatohepatitis) and double check the liver (initially a biopsy, but overruled by Foreman to an ultrasound examination), but before they can perform the testing, Andres becomes more violent that ever, punching his wife, and requires sedation. At this time, the team also notices bloody urine. The differential diagnosis now consists of rhabdomyolysis (severe sudden muscle damage) and TTP (thrombotic thrombocytopenic purpura). House thinks TTP fits best, and orders Andres started on plasmapheresis.

Overnight, Andres elopes (the medical term for a patient, especially a demented one, who leaves the hospital). In the middle of a snowstorm, the team tracks him down to an old soccer field, but by the time they find him, he is hypothermic and pulseless. CPR is started, because, as Chase reminds Adams, they’re not dead until they’re warm and dead (sudden hypothermia can sometimes be protective of a patient, though this is more common in children than in adults, so it’s medical tradition not to declare someone dead until they’re back to normal temperature). Andres is brought back to the hospital, sent to the ICU, and started on extracorporeal warming of his blood. As he warms up, his brain function returns, then his heart. He’s initially in ventricular fibrillation, but he returns to a normal rhythm after some amiodarone (a medication used to suppress heart arrhythmias) and defibrillation. Unfortunately, he seems to have lost his ability to speak English and now only murmurs in Portuguese, his native language. He also develops a fever, but is this a symptom of his original admitting disease, or a consequence of being hypothermic? Looking over Andres’ symptoms, House sticks with the diagnosis of TTP and wants to resume plasmapherises. Foreman, instead, favors a viral infection that has spread to the brain to cause encephalitis. House relents, and has the patient started on interferon.

Andres is not doing any better. He falls back into ventricular fibrillation and this time requires three shocks to correct (apparently they neglected the amiodarone this time around). Foreman maintains it is a viral infection of the brain, such as encephalitis or meningitis, while House now favors toxin exposure. This week, it is Foreman who has the Eureka! moment while talking with some hospital donors. Seeing a flower bouquet still looking fresh despite being over a week old, he recalls that aspirin in the water can prolong the life of cut flowers, and this leads him to diagnose the patient with Reye’s syndrome. Some corticosteroids and Andres is back to normal (well, as normal as someone with early onset Alzheimer’s can be.)

Meanwhile, Wilson is treating a patient with a bladder infection (which he apparently diagnoses by palpating her neck). In the course of his discussion with her, he learns that she and her husband are self-proclaimed “asexuals”, completely disinterested in sex. House finds this head to believe and wagers $100 that he’ll find a medical cause for the lack of sex. He runs tests on the patient’s blood, but everything is normal. He eventually lures the husband in for an exam and discovers a pituitary tumor (a “macroprolactinoma“) that is suppressing the normal sexual urges. With some treatment, the high levels prolactin can be treated and the patient’s symptoms (in this case his nonexistent sex drive) corrected.

As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

Pet peeve here: Defibrillation does not “shock the heart back into rhythm.” The shock from defibrillation momentarily stops the conduction of the arrhythmia, allowing (hopefully) a normal rhythm to take over. The shock itself does not “jump start” the heart or start the normal rhythm, it just stops the bad rhythm — an important distinction.

TTP (thrombotic thrombocytopenic purpura) -– none of three parts (the T, T, or P) fits. There was no mention of low platelets (though other lab abnormalities were mentioned), no clotting, and no purpura. (In fact, there was no mention of rash at all, and rash is almost always seen in Reye’s).

In regards to his symptoms, Reye’s syndrome is quite a stretch with few of Andres symptoms matching well, but then again, Reye’s in adults is quite a stretch in-and-of-itself.

Symptoms of death in the hypothermic do not resolve that predictably (“Ah, 93 degrees, must be time for the ventricular fibrillation”), and frankly, the patient usually remains dead.

Interferon is not a treatment for encephalitis or meningitis.

Cortciosteroids are used in Reye’s to treat swelling of the brain — something they never bothered to look for, despite the more-than-expected behavioral changes.

Third episode so far this season where there is debate whether societally atypical behaviors are symptoms or not. Charity, paranoia, and now aggression.

Before starting statins in a patient with elevated liver enzymes, I’d want to make sure the cholesterol is indeed high and require treatment, as the statins themselves can elevate liver functions.

While there is debate over the use of “chemical restraints” (sedation in aggressive patients), diazepam is unusual for a first line agent. Haldol seems the more common choice. On the other hand, diazepam can be more easily reversed if something goes wrong.

The medical mystery this week was OK, but not great — but that still makes it better than most episodes this season. The big mystery was why Andres developed Alzheimer’s so young, but answering that was outside the scope of the episode. I give the medical mystery a C+. The final solution kind of more or less fit, if you ignored the usual time course of Reye’s Syndrome. I give it another C+. The medicine was uninspiring this week, with diagnoses thrown around that could be easily tested, but never were. Plus Foreman, a neurologist, was using meningitis and encephalitis interchangeably. I give the overall medicine a C. The soap opera was enjoyable this week from the pathos (Chase), to the humorous (the yellow cards, Park and her “tapping”), to the unethical (House and Wilson). It deserves an A-. (Bonus points for the Spider-Man allusion. And what manga was House reading when first talking to Wilson? Maybe someone should tell him they’re read right-to-left, not left-to-right.)

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

The doctor is working hard to “pull them thru” by…doing what, exactly? Putting a warm washcloth over their eyes? Tucking them in?

Now, I’m no expect on knockout gases, but I think I could do better than that.

I like the way there’s a list of rules on the back wall. I can only imagine what they say: “No roughhousing,” “No running with scissors,” “Wash your hands before returning to work”

The Mayor of Metropolis summons Superman because he needs his help. It must be some major problem, right? Like a failing dam, a fire at a hospital, or an orphanage perched atop an EPA super-fund site, right?

Nope. The mayor has the measles, yet still wants to attend the City Council meeting. Truly a problem requiring all the abilities of the Man of Steel (sorry, orphans, try to enjoy the searing pain from the toxic waste).

This is Superman, so he must have a brillaint plan to “beat those measly measles,” right? Wrong again. No shrinking down and battling the evil virus and its zombified cells. No jumping forward a few years in time, grabbing a measles vaccine, then jumping back in time to before the mayor was infected. None of that. Instead, Superman visits a glass factory and makes a giant glass globe.

Then he plunks the mayor in the sphere, along with his desk, some papers, and what looks like a very limited supply of air, and flies him off to the City Council meeting.

Mission accomplished.
This was truly a job for Superman.
Join us tomorrow when he helps City Councilman Adams take an old couch to the curb for trash pickup.

An average episode of Fringe that had too much bad science (and math) for me to truly enjoy. I guess we need some mediocre weeks to let us enjoy the good ones.

The Plot: Emily is a teenager who occasionally catches glimpses of someone’s pending death. She quickly sketches the scene she sees in her sketchbook, rips out the page, and then hands it to the victim. She’s essentially Cassandra, and her warnings of imminent death do no good to the victim. They do bring her to the attention of the Fringe Team, especially Olivia, who is still coming to terms with the Observer who told her that she had to die.

Emily gives the Fringe Team a sketch she made showing numerous victims amid piles of rubble. The image is centered on one particular man. The team is able to figure out who he is via his bus pass. Walter hypnotizes Emily (using the standard red and green lights) to gain more information and learns that the disaster will take place at a courthouse. Olivia and Lincoln learn that the man in question recently lost custody of his children in a divorce proceedings. They track him down to a local courthouse and the FBI finds a large bomb in the bed of his pickup truck. They are able to block the radio detonator, but he threatens them with a small bomb he is wearing. Olivia is able to talk him into surrendering and no one is killed. For once, Emily’s prediction does not come true.

When Olivia calls Emily to thank for her help, she learns that she is missing. Olivia tracks her down to a pond-side bench at a park she was fond of. Emily has foreseen her own death and has come to her favorite spot to die, which she does, quietly, in the arms of her father.

Later in the evening, Nina Sharp comes over to Olivia’s apartment to check on her. Olivia complains about the migraines she’s been having (the ones caused by Nina’s secret injections), so Nina promises to send over some “new medicine” the next day.

1. Math Must Be Different in Spain
The math Olivia and Broyles use on the Spanish Flu doesn’t add up. If the last case was 1919, then 91 years later is 2010, not 2012 (or even 2011, when the episode was undoubtedly filmed). Unless they are suggesting that 1 and 2 year-old do not make antibodies, which would contradict years of immunization and vaccine research.

2. Billy Squier
An “overload of electrical energy in her brain was just too much” is not the definition of stroke; it’s the definition of a seizure. A stroke is what I like to call a “plumbing problem” – the required blood cannot get to the brain either due to a blockage (embolic stroke) or bleeding out (hemorrhagic stroke). A problem with the brain’s electrical system would be a stroke, at least in the sense Olivia is describing.
Neither of these would account for the bloody nose, so I’m going to count that as a psychic nosebleed.

3. Scan Acquired
I’m amazed Walter could get such an accurate reading from the occipital lobe when he had no sensors anywhere near it.
Theta-1 waves are said to occur during voluntary motion and REM sleep, though the exact definition of a theta-1 wave varies.
Theta-1 waves originate in the hippocampus, a part of the brain which is nowhere near the occipital lobe.
Since blood carries oxygen, it would be hard to get increased oxygen without increased blood. And since when does an EEG measure either?

4. Radio Free Albemuth
Now I’m no radio-specialist or electrician, but is it really that easy to jam a specific frequency? How did they know they weren’t going to set off the bomb by accident?
Was it wise to send Peter and Lincoln, not trained in demolitions, it to help the bomb squad? Particularly in regards to Peter, he’s one of a kind and is it really worth risking him?

5. Must Be Those Ceramic Wires and Electrodes
So the bomb Albert was wearing had not detectable metal in it? Really?

6. Oh By The Way
When are the Fringe Team finally going learn that they need to sit down and have a long debriefing session with Peter. How many times has he recognized something they didn’t or knew more than they did? Just off the top of my head: shapeshifter’s memory banks, David Robert Jones, and the Observers. I’m sure I’m missing a few others.

While there was nothing specifically wrong with this episode (other than the questionable science and math), it just didn’t gel particular well, with the attempt at pathos at the end being a more than a little over-the-top. The Fringe Doomsday Clock heads back towards midnight.

This week’s Fringe cipher was: MARCH.
A list of all previous Fringe reviews is available here.
Karl should soon have more to say over at his blog, providing he’s not partying too hard on his vacation.

Tags: television fringe precognition bomb hypnosis

This week, Roxana wins with 9 points. Harvey, Little apple, rileyjo, Rouge Rogue, Silvina and TheJester were second with 8 points.

Overall, James H retains the lead with 46 points. Dr. R moves back up to second with 44 points. Nextsundayad and Roxana are tied for third with 42 points. wkmaier is fifth with 40 points. If you have 35 or more points, then you are in the top 10%.

Click here to see the full scoreboard.

House shows some heart in tonight’s episode, unfortunately, he seems to have left his brain at home.

A teenager presents to the Princeton-Plainsboro Hospital clinic complaining of some difficulty breathing. All she wants is an inhaler for her “asthma” but House correctly recognizes that she is homeless and the man with her isn’t really her father. What really piques his interest is when she starts bleeding from her ear. He mentions that this is a sign of a skull fracture, but can find no fracture — or any other cause of the bleeding — so he admits her to his service. The team’s initial diagnoses focus on her homelessness and consist of drug use, malnutrition, or HIV. Chase goes further and suggests she may have a squamous cell cancer of the middle ear with paraneoplastic syndrome, while Taub, backed by Adams, suggests a possible cerebral (brain) infection, probably pneumococcus. House agrees with Taub and Adams and starts “Jane Doe” on ceftriaxone (a potent antibiotic).

Adams and Park check out Doe’s school — where she is doing quite well — and also check out her address on record with the school, which is a foreclosed home she has fixed up. Looking around the house, Adams finds a few beers and some mold. She now suspects Doe has a fungal infection and starts her on fluconazole (an antifungal medication). Upset that the team went behind her back digging into her history, Doe tries to leave, but collapses as soon as she gets out of bed, complaining that she “can’t feel her legs” (her symptoms are later identified as paralysis, which is different from the paresthesia she was complaining of).

Looking over her symptoms of ear bleeding, problems breathing, and lower extremity paralysis, the team’s new differential diagnosis is transverse myelitis, endocarditis with septic emboli, or the fairly vague “vasculitis” (inflammation of the blood vessels). House goes with the vague and starts the patient on steroids to treat the presumed vasculitis. Initially, she is doing better on the steroids, but then things quickly go to hell. Her estranged mother shows up, identifying the patient as Callie, and in the middle of the confrontation, Callie begins coughing up blood. Different diagnoses are considered based on where the blood may be coming from (respiratory or gastrointestinal source). Chase suggests she has a sinusitis and a bleeding disorder, and Adams suggests Zollinger-Ellison syndrome (a condition where the patient has a tumor which secretes gastrin, which causes the stomach to pump out too much acid). House thinks Adams has the better idea and orders an EGD (upper endoscopy), which reveals bleeding ulcers in the esophagus; unfortunately, this doesn’t fit any of the diagnoses discussed. The team now considers the diagnoses of HPV (human papilloma virus), alcohol-induced esophagitis, or a berry aneurysm of the brain. House thinks it is the aneurysm and wants a quick cerebral angiogram followed by surgery before the aneurysm has a chance to rupture, which would rapidly kill her. Adams favors the alcohol theory — Callie does admit drinking an occasional beer — and Callie’s mother agrees with Adams and decides to forgo the angiogram and surgery. Callie seems to be doing well and is actually talking with her mother when she suddenly falls unconscious. Coudl she have had a berry aneurysm which burst? Was House right? She is rushed to the OR suite for the cerebral angiogram, but no aneurysm is detected. Her blood pressure begins to plummet and the team buys time with some pressors (medications that increase blood pressure), but still don’t know what is wrong her. Brainstorming, Adams first suggests cancer, then recalls hearing about a trip Callie took to Florida two years before and wonders is she may have contracted dengue or cholera. House (rightfully) scoffs at those, then after learning Callie went swimming in a freshwater canal while in Florida, correctly diagnoses her with ascariasis (a parasitic worm infection). After Callie is treated, she sneaks out of the hospital to be on her own again, still unwilling to trust her mother. (I’m assuming she snuck off to the Disney Channel, where she was able to find a much happier family).

As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

House dismisses Adams suggestions of dengue and cholera by pointing out the two year gap between exposure and symptoms, but then diagnoses ascariasis, which has precisely the same problem. The worms would not have sat quiescent for two years, not when they had their preferred environment, no matter what the fancy graphics at the end showed.
I’ll grant that ascariasis can cause pulmonary symptoms and gastrointestinal symptoms (because the worms travel intestines to liver to liver blood flow to lungs, then up the trachea, and swallowed back down to the intestines). Ears (and even if they could get to the ears, how were they causing bleeding? Drilling a hole?)? Brain (and yet not be visible on CT scan)?

Ears should not bleed. House looked in Callie’s ear and said it was normal. I would expect him to see a bleeding source (such as a scratch, cyst, infection, etc) in the canal, or a hole in the tympanic membrane which would let blood from deeper in the ear out into the canal. He mentioned neither of these – so how could there be blood?
Other than Chase’s mention of squamous cell cancer of the ear, none of the diagnoses mentioned are going to cause ear bleeding, particularly ear bleeding that looks normal on exam. For example, Zollinger-Ellison? How is a gastrin-secreting tumor going to cause ear bleeding? Callie only has four symptoms, and Adams still skips one in her diagnosis

Taub’s phrasing “cerebral infection” was a odd. He seems to be suggesting meningitis — for which pneumoccocus is a common cause and ceftriaxone a good choice of medication — but that doesn’t fit with Adams comment about lack of fever. You would expect a fever — and meningeal signs — with meningitis. They could possibly be referring to a brain abscess, but that would have shown up on the CT, and pneumococcus (and thus the choice of ceftriaxone) much less common.

No vaccine is 100% protective, and Callie could still get pneumococcus even after being immunized. Plus, the vaccine only covers a handful of different pneumococcus serotypes (admittedly the most common), and she could have been infected with one of the serotypes not covered by the vaccine.
Why would Adams, who doesn’t believe much of what Callie says, believe a shot record to be true? Callie likely forged or lied on her school shot records. It’s not like her parents really signed it.

When Callie stands up and collapses to the floor, she complains she can’t feel her legs (paresthesia). That’s different that an inability to move her legs (paralysis). It’s possible she has both and can’t move or feel her legs, but then the most common complaint would be that she couldn’t move her legs, not that she couldn’t feel them.

PPH is in for some tough times. In the past two weeks, they’ve let two patients escape– two they should have been watching closely. Last week, a patient with Alzheimer’s (known to be elopement risks), and this week, a minor left AMA, a minor with a history of running away.

I found the medical mystery to be more interesting than usual this week, because the symptoms were quite disparate. I give it B. The final solution was a let down, because it couldn’t really explain half the symptoms (and the most interesting half at that); it deserves no more than a D. The medicine was very sloppy this week, with many of the diagnoses not explaining all the symptoms — and there were only three or four symptoms to work with. I give it a C-. The soap opera was adequate and average. There were a couple of nice scenes, and Wilson got a few good lines, but it really wasn’t anything above average: C.

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A list of all prior House reviews

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I’ve got nothing negative or snarky to say today, I think the Special Olympics are a great organization and I’ve had a great time every time I’ve helped them (and apparently I helped Superman as well).

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