Lexicillin QD

How NOT To Use Powerpoint By Comedian Don McMillan

Very true:

The National Museum of Health & Medicine: archival images on Flickr

Earlier today, I had a phone conversation with Michael Rhode, Archivist at the Otis Historical Archives, National Museum of Health and Medicine, Armed Forces Institute of Pathology (AFIP) in Wash, DC.

This was prompted by a blog post I read at Morbid Anatomy [the really old term for the discipline now called pathology] detailing the project by the Museum to post images on Flickr, so that the general public can use them as they wish or make comments on Flickr that might help explain the content of the photos. BoingBoing.net also picked up this story, but Michael tells me that access to this site is blocked at the AFIP. (Those subversive BoingBoingists.)

They've been creating groups on Flickr since 2006, uploading about 200 photos to each group, here, and here, and these are the favorite photos from the Archives staff.

This will give some background into what they hope to accomplish:

The National Museum of Health and Medicine (NMHM) of the Armed Forces Institute of Pathology has been working with Information Manufacturing Corporation (IMC) to scan its Medical Illustration Service (MIS) Library. The MIS Library is one of the NMHM's largest collections, with 4,500 boxes of medical photographs.

The Library was transferred to the Museum in late 2004, and houses millions of photographs from World War II through the 1990s representing diseases and their effects on humans and animals.  Included in the collection are rare illnesses such as smallpox and the Asian flu. Over 71,000 images have already been scanned and are currently almost completely catalogued and indexed including three major groups of photographs:  the Museum and Medical Arts Service (MAMAS) photographs taken by Museum staff during WWII in Europe and Asia, images from the "Atlas of Tropical and Extraordinary Diseases",and historical portraits.

This year scanning includes 200,000 pictures dating from US involvement in World War I while also adding other military medical photographs from the Civil War, the Spanish-American War, and the Vietnam War to a database of images. Medical histories published by the U.S. government on the Civil War (6 volumes of "The Medical & Surgical History of the War of the Rebellion"), World War I (15 volumes of "The Army Medical Department in the World War", and the Spanish-American War ("The Use of the Roentgen Ray in the Late War with Spain") will be completely digitized, as well. Within the next year, the Museum and IMC will have created a major digital resource for researchers.

Michael said to me that part of the reason for this project, besides the historical perspective, was to make images available that simply didn't exist on the Web. They uploaded this picture of a cystoscope as it is used, inserted through the penis and used to view the inside of the urinary bladder. The was some discussion whether this image was appropriate for the Web, but it was decided that it had a special value in being the only image of its kind available that shows this procedure.

Too often we see human anatomy rendered in candy-colored 3D CGI where it seems more the aim to entertain, and grab the eye than to try to represent reality. Considering the range of images available on the Web, I think this image is innocuous.

I mentioned that I hoped that this images wouldn't be seen as just another type of curio for the Web viewer or wallpaper for the jaded. It's important to use these images to discuss medical procedures, as a way on enhancing medical literacy on the Web, rather than just regarding them as quaint.

Michael has co-authored a paper, Connor, JTH and M Rhode. "Shooting Soldiers: Civil War Medical Images, Memory, and Identity in America," Invisible Culture 5: Visual Culture and National Identity (Winter 2003),  about the evolution of photographs taken of the wounded during the Civil War. While these photographs were originally taken, collected and studied for scientific purposes, they eventually were shown to the public and became "...iconic symbols of a battle-worn and badly injured American nation."

This image taken 10 years earlier, was displayed at the Centennial Exposition in Philadephia in 1876. The photo shows that  the patient was wearing a real leaf, but in most cases, a leaf was painted on the negative so that each print made would be discreet. This obviously doesn't protect the privacy of the subject, but was necessary to protect to public from the sight of genitalia while war wounds, amputations and other deformities were not considered offensive.

I've been fascinated by the influenza outbreak of 1918 and American society under Woodrow Wilson with his American Protective League having read John M. Barry's The Great Influenza, so I was pleased to see photos and other materials related to this pandemic on their Web site. The press at that time were under severe constraints of censorship against any reports that our troop strength might be compromised by this disease, so photos and stories were supressed. It was called the Spanish Influenza since it was in that country that the press could freely pass along the information it was receiving. This is even though it is widely believed to have originated in Kansas as the US stepped up its involvement in World War I. As the soldiers went off to war, It then swept through North America, Europe, Asia, Africa, Brazil and the South Pacific, with mortality estimates as high as 100 million.

This is a photo from Camp Funston, Kansas during the beginning of the outbreak:

This is a segment of a document you can download as a PDF:

Transcript 'History of the Base Hospital', "Camp Mills" Mineola, Long Island, New York. Written by Theda E. Schulte, A.N.C., while on duty during the month of August 1919, between the hours of 1 and 5 A.M. Completed September 15, 1919.

In this passage it mentions toll the virus took on the nursing staff: "Some of the Nurses were stricken; every day our nursing force became smaller."
 

Some other resources I found out about during my conversation is the University of Copenhagen and its blog Biomedicine on Display, which is about its medical museum. It goes so far as to examine the philosophical and cultural aspect of depiction of the human body and other biological images.

The Wellcome Collection also has images related to medicine and war. They have over 160,000 images online, and they've just changed over to a Creative Commons license.

Please note: In some instances I'm editing and enhancing the images I've downloaded for clarity's sake, since I'm mostly interested in the informational content provided by these wonderful images. For instance, in the first photo of the two nurses, I cropped it and lightened the shadow detail a little to catch more of that smirk on the nurse on the right.

Really bad PowerPoint

I just quit a Webinar after 15 minutes of non-information. It doesn't matter what the presentation was about, it just lost me right from the start.

First, the slides of the PPT presentation were loading slowly because of the fancy logos and graphics that provided no information whatsoever.

Next, came slide after slide of management speak, as you see in this slide disguised to protect the boring party talking about their mission statement.

Advice: your first slide should be the heart (pun?) of your message. Then follow with the slides that support this. Bullet points should be outlawed. The semicolons make it look like legal document.

Also, start your presentation without apologizing endlessly for the slides. It's as if they were pieces of photographic film that are not easily replaced. One of the speakers (btw going back and forth with two speakers is another distraction) said "These first slides really go slowly." I guess you're telling me you haven't practiced this presentation beforehand. I got the impression that this person was seeing these for the first time, and reading them while trying to make chatter.

Mean vs median and blogs

Seth was making a point on the measures of central tendency, specifically how the mean page views by a blog visitor might not be the best indicator of a typical visitor to your blog.

I made these graphics for a lecture I'll be giving about medical statistics, to give a description view of the two types of skewed distributions. The first, the negatively skewed distribution is what Seth is talking about where the mean has a lower value than the median. In the second, the positively skewed distribution, you might think about the distribution of income in a particular country. [NB: the actual values of mean and median were were not calculated. The mode is what it is, the value with the greatest frequency.]

SciVee alpha: the video-sharing community for science topics

Associated with the PLoS, SciVee was developed by Philip Bourne, a pharmacology professor at UCSD, to allow the sharing and tagging of user-generated video.

SciVee: Pioneering New Modes of Scientific Dissemination | Pioneering New Modes of Scientific Dissemination

Technorati Tags: plos, Scivee

What makes a really bad medical story headline?

These are the attention grabbers for our jaded Web eyes and ears, meant to target our emotions, mostly fear and anxiety. But don't read the whole story, because then you're in for a big letdown. 

"Cell Phones in Hospitals: Bad Rx" (From Time online) & "Turn that cell phone off!" (This is a video report on CNN Health, but you have to watch a commercial for Momma Mia! before you get to the good stuff.)

Turn a minor study into a reason to panic!

This study examined the possible electromagnetic interference (EMI) of cell phones with the medical monitoring equipment or mechanical ventilators used for the very ill patients in hospitals. You'd think that by answering your cell phone in a typical patient room you would wreak havoc on the ward. But most of us know that this doesn't happen.

If you read the whole Time report on the study, you'll find out the interference mostly occurred when the phone was held some 3 cm (< 1.5 inches) from the medical equipment which is mostly used in the CCU of the hospital where access is restricted anyway. Plus, the phones they were using were operating at higher power levels (at least 3x according to an electrical engineer doing similar research) than cell phones in the US.

Common sense comes into play here. Hospitals have set up guidelines were they stipulate that you keep 3 feet away from this equipment, just to be on the safe side. Besides, if you're getting that close to someone that sick, you should be more mindful of infection control, and wear a gown, mask and gloves without pulling out your grimy cell phone.

The following are headlines I made up, to serve as examples, and to make a point. And, sometimes the copy doesn't fully correct what the headline is claiming.

"New hope for diabetics"

If it were that simple to give people hope from a single scientific study. I wouldn't be too cynical in saying that sometimes a financial interest is at stake. The next group that tries to reproduce the results might find the opposite effect of the treatment or drug being studied, if these results are published at all.

Even if the therapy is further into clinical trials or approved by the FDA, this doesn't even take into account what adverse effects begin to crop up after it's tried with a very large number of patients followed over an extended period of time.

Also, calling people "diabetics" plays into the shame of being labeled as one of *those* people.

"Smokers who eat chocolate found to have fewer heart attacks."

Provide an easy solution, that just so happens to taste good too, but ignore the bigger picture. It's like when you walk into a liquor store and you see this newspaper article taped to the front door at about eye level that says, "Red wine is good for your heart!" 

But there's something else wrong here. This is the old confusion of causality versus association. Very few studies are rigorous enough to prove A causes B.

Most probably what was done was a retrospective case-control study where a group of similar people, i.e. smokers, where put into 2 different groups depending on how much chocolate they said they ate in the last 20 years, and then check their cardiac history. The study might reveal an association, correlation is a better word, but they can't say that it was the chocolate that protected the heart, nor could they suggest that if you're a smoker you'll get a benefit by making a determined effort to eat more chocolate.

The studies needed to prove causality are very difficult, if not impossible to do. You have to do a prospective, randomly-controlled, double-blinded study. Which means you'd have to select a group of smokers who are very similar to each other in lifestyle and behavior (forget about trying to control for genetics), and then randomly assign each to either a chocolate-eating group, or a control group  which eats something that looks, smells and tastes like chocolate but isn't the real deal. Then you have to follow them long enough until a significant number have reached your end point, a cardiac event.

You're better off just trying to convince your readers to stop smoking.

"Guys, are you doing the erectile dysfunction two-step?"

Whaaaaaaaat?

UPDATE: A car commercial

"Will you love me when I'm sick?," says the 5-year old to her mom.

(more copy)

"While you can't engineer love, you can engineer safety."

Hsien-Hsien Lei's blog, "Eye on DNA"

Great mix of science and culture about DNA topics.

Eye on DNA — How’s it going to change your life?

Technorati Tags: Eye on DNA, medical media

Powered by ScribeFire.

"Everything Is Miscellaneous": a must read

  Everything Is Miscellaneous 
  Originally uploaded by BKMD.

In Everything Is Miscellaneous, David Weinberger has assembled a collection of stories about taxonomy which when taken together implicitly gives us a meaning of the new digital lifestyle enabled by the Web. This includes finding  and conversing with others who share our interests.

In some ways, you can say that Everything Is Miscellaneous is the work of an amateur—but in the absolute best sense.

Amateur, not in the sense of Sanjaya and American Idol, but rather like Matthew Brady, beginning the discipline of photography by struggling with a load of equipment including glass plates and darkroom tents to photograph Civil War battles. Or maybe John Snow, the physician who developed the data gathering tools that would define the discipline of public health in order to prove his waterborne theory of cholera spread over the pervasive miasma myth.

Similarly, David Weinberger is a passionate participant in the new discipline which doesn’t have a name yet. He’s far ahead of anyone who tries to claim expertise in this new field. But what is it? What’s it called? Where does this book go on the bookstore shelf? It’s not strictly about library science, or business.

This week I attended a talk by David at the SIBL library here in Manhattan, which maybe makes sense when dealing with taxonomy and the work of Dewey, but I felt that he would have been better appreciated by grammar and high schoolers who are already using collaborative networking ala SMS. But, he did dedicate this book, “To the librarians.”

The problem that David tackles in this book is the deficiency of the concept hierarchies used to sort and define entities. For example, he looks at the Bettman Archive to show how categorizes in a tree-like schema or hierarchy eventually falls apart in utitility. But this also echoes the evolution of database design. Databases based on hierarchies can handle one-to-many relationships, say for a medical database, one physician connected with many patients, but once that patient seeks a second opinion, she is connected to another tree. Handling these many-to-one relationships led to concept of the relational database described by EF Codd, and is now the major model, used by Oracle, MySql, etc. Advance techniques such as data  mining  can then be used to discover new, implicit relationships.

In the same spirit, the digitization of data and metadata, photos, books, maps, news stories, and interpretations of Hamlet can now be freed from the traditional hierarchies, and thereby “miscellanized.” These entities or "leaves" can then be attached to multiple trees depending upon the  semantic tags attached to each leaf. The underlying concept hierarchy can remain in place, but now strange and wonderful and messy things can happen at the periphery.  The sorting process can happen spontaneously, without restriction, without  a priori assumptions.

Within the field of medical publishing, David gives his views of the peer review process in his last chapter, "The Work of Knowledge."   He notes the experimentation that is occurring in a very traditional field:

So in June 2006, Nature began a three-month experiment in which authors could agree to have their submissions posted for open comment, although the comments had no effect on which papers were accepted for publication. Campbell [Nature’s editor in chief] lists some other ideas the editors have been discussing with various degrees of seriousness, including providing each published author with a blog where readers can comment.

He also discusses the online publishing organization ArXiv which he notes is not necessarily the bottom-up counterpart to the top-down Nature:

The third order [digitized data] is an ecology with niches of every sort. What starts out in the third order as open, authority-free, and permissionless can find itself evolving in unexpected ways.

The Public Library of Science (PloS), another effort to put more research in the public domain, was created by editors of peer-reviewed journals. All these efforts found their reason for being because of the Web.

If you’re getting your information more from the Web than the main stream media, as more of us are, you’ll need to find how to gain the best experience, either for entertainment, self-edification, or strategies for competing with other businesses. David explains it in his latest book, not as an observer but as the Web's most dedicated participant.

Technorati Tags: everything is miscellaneous, David Weinberger, metadata