• 20:32 My hobby: accidently terrifying night janitors with my dimly-lit office visage. #
• 22:32 Cmar-bloggery: : John Cmar 360 saintnickanuck.com/blog/2009/11/20/john-cmar-360/ #
• 23:13 Cmar-bloggery: boobs, or #HoNoToGroABeMo Day 20 - bit.ly/8L7lqm #
• 23:15 Now, @moonrangerlaura and I head to #Philcon, and Cherry Hill, NJ TREMBLES. Or something. #
• 03:11 RT @moonrangerlaura: It is the insane hours of the morning but @Cmaaarrr & I have arrived at #Philcon. Our schedule: bit.ly/5bbdcY #
• 03:11 I <3 The Adoration of the Mi-Go. That is all. #Philcon #
• 03:18 Go eagle go! RT @SwineFluNewsUSA: Norway Announces H1N1 Swine Flu Mutation Discovered tinyurl.com/yjypewg #pandemic #usa #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

I was recently interviewed by Philip and Lisa Mulford for this week’s episode of their audio show, Communication 360. From the episode description:

Every day [swine flu] is in the news, often with conflicting information. Even the medical community is inconsistent. So what do you do? And more importantly what is the best decision for your child? Having already experienced the H1N1 with both their boys, Philip & Lisa are joined by infectious disease specialist Dr. John Cmar to identify the fact from the myth and put the H1N1 back in perspective.

Communication 360 in general focuses on the different roles that communication has in relationships, understanding how it can break down, and ways to mediate it after it has. Given how much of the recent “swine flu” hysteria has been due to often poor communication from news media and medical authorities to the general public, I was eager to explore influenza from this perspective.

Our hour chat was fun, and ended up covering a lot of ground. We had a good discussion of how many aspects of talking about influenza – such as basic questions like “is this a bad flu season?” or “is there more than one H1N1?” – are not straightforward, and require a nuanced discussion that is often difficult to communicate to laypersons in limited time. There were many questions raised that I didn’t have a chance to discuss in detail, including some aspects of influenza vaccines and overhyped side effect possibilities. Now that some of the reactionary influenza coverage has died down a bit in the media at large, I’ll be taking a closer look at some of these issues in future posts.

Go here to listen to the program, and remember: wash your hands, people.

(Please note that I was accidentally credited as being an “infectious diseases specialist at Johns Hopkins” early in the episode, but this was corrected later on in the program to reflect my infectious diseases and clinical work at Sinai Hospital of Baltimore, and my teaching appointments through Johns Hopkins University.)

• 08:12 @moonrangerlaura @scifilaura A most wonderful and happiest of birthdays to you! #
• 09:15 Sinai Hospital of Baltimore medical grand rounds this week: "Gout in 2009" with Dr. John Meyerhoff #
• 20:11 At Hard Times Cafe, treating @moonrangerlaura to her requested birthday meal. Because I MUST. #
• 20:13 @jbcrail Indeed, I am. And no apologies - it is a testament to your twistedly keen eye for detail. #
• 22:58 Cmar-bloggery: some days, it's what you don't say, or #HoNoToGroABeMo Day 19 - bit.ly/41xHzF #

• 21:57 Facebook notifications I never thought I'd receive: "xxxx suggested you become a fan of Baltimore City Health Department..." #
• 22:47 This contains all that is good in life: RT @pkdmedia: The PKD Black Box #1: Destro McDonald & The Doobie Bros.tinyurl.com/yf3hqh5 #
• 00:03 Cmar-bloggery: PENICILLIN, or #HoNoToGroABeMo Day 18 - bit.ly/4wakpi #

• 08:45 A new slogan for #HoNoToGroABeMo RT @warrenellis: the term "beard" shall henceforth be replaced by "crackling virility hedge" #
• 12:54 @moonrangerlaura Yay!!! *whew* #
• 13:36 One of my residents just won a $900 medical moustache scholarship for his crackling virility hedge. Not kidding. I am so proud! *sniffle* #
• 21:30 RT @comics_grrl: twitpic.com/pxr07 - Come see me at Durham ArtWalk this weekend, Nov 21-22! 610 W Main St! Burger truck nearby! #
• 23:26 Cmar-bloggery: crackling virility hedge, or #HoNoToGroABeMo Day 17 - bit.ly/4hpdeN #

• 16:31 I am obligated to RT @jrblackwell: One of J.C. Hutchin's best tweets EVER: RT: jchutchins @jrblackwell Or they get oral herpes. #
• 17:46 @jrblackwell I know! I wanted to be on that panel, for that very reason. I have more than one axeless plan, by the by. #
• 18:43 Cmar-bloggery: : Philcon 2009 schedule bit.ly/4rGumZ #
• 22:12 In which I am profiled, after a fashion: RT @KJToo: Better Know a Beard: Dr. John Cmar bit.ly/3aNDMo #Beards4Boobs #
• 22:39 Cmar-bloggery: i disapprove of this mating ritual, or #HoNoToGroABeMo Day 16 - bit.ly/4rA4we #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

And here, I thought the convention season had ended…

A few weeks back, Laura happened to be perusing the guest list for this year’s Philcon (including Cory Doctorow, among esteemed others), and suggested that it might be a fun way to round out November. I agreed, and lo and behold – we are headed up to Philcon this coming weekend. Or, rather, CherryHillNewJerseyCon, based on the actual location of the hotel, but I digress…

We both have the pleasure of contributing to the science track as guests. Given the lateness of our declared attendance, the more infection and zombie-related panels were already gobbled up (heh, and drat), so my schedule includes some interesting but decidedly different panels than the norm:

Sat 1:00 PM in Crystal Ballroom Three (1 hour)
STEM CELLS: RESEARCH AND PROGRESS (171)

[Panelists: Jed Shumsky (mod), JJ Brannon, John Cmar, Jay Wile]

There has been much progress in stem cell research in recent years, with new discoveries coming regularly. In January 2009, Geron received FDA clearance to begin the first human clinical trial using human embryonic stem cells. What is happening today and what still remains to be done before the promise of stem cell therapy becomes reality?

Sat 6:00 PM in Crystal Ballroom Two (1 hour)
GREAT MYSTERIES OF SCIENCE (169)

[Panelists: Eric Kotani (mod), Eric Schulman, David Goldberg, John Cmar, Frank O'Brien]

What are the most important unsolved mysteries and unanswered questions in science? Which are closest to being solved?

Sun 12:00 PM in Plaza I (One) (1 hour)
THE BIOLOGY OF OBESITY (166)

[Panelists: John Cmar (mod), Muriel Hykes, Jed Shumsky, James Prego, Lawrence Kramer]

Obesity is a growing problem around the world, and increasing research has revealed the causes to be much more complex than just “eating too much.” Medicine now recognizes that some people will
gain more fat from the same amount of calories than others. Hormones, gut bacteria, brown fat, neurotransmitters, metabolic pathways, viral infections, circadian rythms and many other factors
are all now implicated in weight gain and loss. Are we closer to understanding the causes of and solutions to the obesity epidemic?

And Laura’s schedule:

Sat 1:00 PM in Plaza VI (Six) (1 hour)
NASA FOR KIDS (154)

[Panelists: Andre Lieven (mod), Laura Burns]

A fun and educational discussion about the U.S. space program.

Sat 3:00 PM in Crystal Ballroom Three (1 hour)
SPACE INC.: IS PRIVATE ENTERPRISE THE FUTURE OF SPACE DEVELOPMENT? (183)

[Panelists: Laura Burns (mod), Mark Wolverton, Frank O'Brien, Dr. H. Paul Shuch, Karl Kofoed]

With NASA struggling with budget restrictions, and other governments around the world facing economic crises, the private sector may now be poised to become the main route to space. What is happening in private space development? What’s planned? What’s likely and what’s not? And is this a good or bad thing for the future of space exploration and development?

Sat 5:00 PM in Crystal Ballroom Two (1 hour)
SCIENCE AT THE HEART OF SCIENCE FICTION (87)

[Panelists: Bud Sparhawk (mod), Caroline Cox, David Goldberg, Dr. H. Paul Shuch, Jerome Stueart, Laura Burns]

How has Hard Science Fiction changed in the last decade? Is Science Fiction still predominantly the literature of scientific ideas?

Sun 11:00 AM in Plaza II (Two) (1 hour)
THE WEIRD SCIENCE FAIR! (125)

[Panelists: Christopher Gay (mod), Mark Wolverton, Laura Burns, Eric Schulman, Caroline Cox]

Death rays.  Earthquake generators.  Ice Ages that cover New York in 24 hours.  SF books, movies, and TV have offered up some STRANGE science over the years.  Here’s a panel to talk about some of the
Weird Science we’ve seen.

If you are at the con on Saturday or Sunday, feel free to say hi. I’ll be plugged in via Twitter, and may attempt daily bloggage while there. *gasp* (Hm… I never did post my Dragon*con post-mortem…)

• 18:05 Cmar-bloggery: : weekly rounds bit.ly/2ISfIV #
• 18:27 RT @moonrangerlaura: I'm in this article tinyurl.com/yjfvlwl Thanks @ChessieCat65! #
• 18:58 @jbcrail True, although I remain confident that said shame and embarassment will return soon. #
• 22:29 Cmar-bloggery: a day of rest, or #HoNoToGroABeMo Day 15 - bit.ly/cOjAC #
• 23:04 @TeeMonster I pick my nose on national TV less - if that's a fetish for you, then your choice is clear. ;) #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

• How Not To Grow A Beard Month grows onward, and finds me blown away by the donations given on my behalf for breast cancer research. Thus far, all participants have raised $1,530 total, and we still have over two weeks left to go in the month! Check out my entries for Day 8, Day 9, Day 10, Day 11, Day 12, Day 13, and Day 14, and if you haven’t done so yet, please consider donating to this worthy cause.

• My three-part “state of the flu” series over at Lifebridge Health I mentioned last time didn’t materialize for several excellent reasons, but I look forward to it showing up in the coming week.
• Laura and I will be attending Philcon next weekend as science guests. It will be great fun, and more on that is forthcoming.

• 23:16 Finally cracked open the Starcraft board game - great fun, and nice choices in adapting the original. Which I now am now craving. Dammit. #
• 23:37 @jchutchins Damn straight. I mean, the first 3 times I unfollowed you, it was because I could smell your vile odor wafting from your tweets. #
• 23:56 @jchutchins I suspected as much. You, sir, are responsible for the sheer excess of penicillin-impregnated nose plugs in my house. #
• 00:11 Cmar-bloggery: the most wonderful time of the year, or #HoToNoGroABeMo Day 14 - bit.ly/4qLNmM #
• 00:51 Heartily agreed! RT @brandg: Great StarCraft Boardgame day with @cmdln, @pfischer, @ljosalf, @Cmaaarrr, and Darth Bonbon. #

• 14:17 You can lead the stupid to the brain-tree, but you can't make them pluck one off and slide it in their head. #
• 22:16 Cmar-bloggery: "Yes, both interstates & parking lots have pavement & lines, but THIS one...". or #HoToGroABeMo Day 13 - bit.ly/3udu26 #

• 22:24 Cmar-bloggery: SYPHILIS, or #HoNoToGroABeMo Day 12 - bit.ly/27rfsS #
• 22:30 @Daecabhir Oh, like I was going to say anything bad. Involving lotion. Or buggery. #
• 22:49 We're ONLY in the company of Lesotho, Liberia, Papua-New Guinea and Swaziland in not having paid sick leave. FFS. - bit.ly/34WJlZ #
• 22:59 Even at the climax of Ragnarok, remember: RT @alphasis: and it is never too late to assert that, yes, @MattFnWallace is indeed the man. #
• 23:04 @MattFnWallace Heimdall's horn is inscribed with KILL THE FEED in runic relief. #
• 23:56 Cmar-bloggery: : tales of healthcare pre-reform bit.ly/toTHl #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

It has become in-vogue for insurance “providers” to contract with a third party company to review (i.e. deny) radiologic studies, such as MRIs, for medical necessity and appropriateness. If they deem that such a study is “not medically necessary,” the process for a physician and patient to overcome it is purposefully onerous and requires a disrespectfully time-wasting amount of phone calls and paperwork.

Approximately one month ago, I saw a 40’s year-old-woman who’s main complaint was knee pain and decreased range of motion. On exam, there was a weird tender lump jutting out from the side of her knee (what I, in medical parlance, described as a “lateral joint deformity”), and I detected some degree of possible meniscal instability on manipulation of the joint. All of this would lead most people with medical training, and some without, to come to the conclusion that an MRI of the knee to specifically examine the soft tissue structures is the appropriate next diagnostic step.

What follows is the phone conversation I had earlier with the third party company involved after fighting with them for four weeks, and subsequently being denied, for the test:

[called  main number, on-hold for 16 minutes]

Operator: “Hello, this is xxx, may I have your patient’s account number please.”

Me: “Hi, this is Dr. John Cmar at Sinai Hospital of Baltimore, how are you doing this evening?”

Operator: “Um… fine. You patient’s account number, please.”

Me: [account number given] “I’m calling to appeal a decision for coverage on an MRI for a patient of mine.”

[information is exchanged]

Operator: “I’ll need to locate a Medical Account Manager for you. Please hold for the physician.”

[on-hold for 22 minutes]

Operator: “Um, I’m sorry sir, but it appears that we no longer service insurance company yyyy. I can’t help you.”

Me: “Really? But I’ve been dealing with you for four weeks. When did this change occur?”

Operator: “November 1st.”

Me: “But I have a letter here from you issuing a final denial on November 4.”

Operator: “Yes… I’m sorry, but I can’t explain it. It makes no sense.”

Me: “I agree. So, what’s my next step? Start from square one and four weeks ago, and issue another referral?”

Operator: “That’s as good an idea as any. I really don’t know. I’m sorry.”

Me: “I’m sure you understand this isn’t satisfactory. Do you have a manager I can speak with?”

Operator: “Sure. Please hold so that I can locate a manager for you.”

[on-hold for 18 minutes]

Operator: “I’m sorry sir, but there’s no manager available right now.”

Me: “… really?”

Operator: “Yes, sir, I’m very sorry.”

Me: “Well… thanks for your help, then. I’ll reissue the referral to the insurance company.”

Operator: “Is there anything else I can help you with today?”

Me: “You… have got to be kidding.”

From a purely practical standpoint, that was from ~6pm to 7pm wasted on fighting futily for coverage of a medically indicated study for one patient, that has been previously delayed for four weeks and will continue to be delayed further. For me as a salaried hospital employee, that’s a personal debt in time and energy… but for a private practitioner, that would be a direct loss of livelihood, and for the patient, an inexcusable delay in specific diagnosis and accurate treatment.

I am thankful that it only took an hour of my time. Oddly, however, I happen to have more than one patient.

• 09:34 Someone just used the phrase "my bad" in conversation. Ah, the 80's... #
• 13:12 After finishing the email, I could not help but utter out loud , "I think that conveys my level of dissatisfaction." #
• 17:45 RT @bengoldacre: Bacteriophage attack!: thanks @paul_snoop bit.ly/1PtMpH #
• 23:01 Cmar-bloggery: go, joe!, or #HoNoToGroABeMo Day 11 - bit.ly/oMkD6 #

• 21:08 Cmar-bloggery: i am a doctor, or #HoNoToGroABeMo Day 10 - bit.ly/3oK6xm #
• 21:13 Great first episode - congrats! RT @pkdmedia: "The PKD Media Blackbox" podcast epi #0 now available! bit.ly/2OnMVM #podcasts #comics #
• 21:56 @jchutchins Speak for yourself. That would have made my night. ;) #
• 23:59 RT @MattFnWallace: Pick up your own copy of MURKY DEPTHS historic Issue X: www.MurkyDepths.com Razor-edge comics, fic, and me. #
• 00:00 Not the most auspicious day when one gets to code for both "tuberculosis" and "pregnancy" in the same patient. #

• 19:31 Cmar-bloggery: no re-but's about it, or #HoNoToGroABeMo Day 9 - bit.ly/1nOOjZ #

• 17:30 Cmar-bloggery: : weekly rounds bit.ly/1twE60 #
• 22:37 @MattFnWallace With glorious food metaphor. "His brain blasted forth from his skull like a tomato-rich cocido madrileño." #
• 23:02 @alphasis YES. #
• 23:41 Cmar-bloggery: LIKE MEN ONCE DID, or #HoNoToGroABeMo Day 8 - bit.ly/2Ll3MF #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

• In what I do find on some level to be amusing, both Laura and I have been waylaid over the last week by what is very likely influenza due to the novel H1N1 virus. Things are returning slowly to a better state of health, and I’m planning a three-part “state of the flu” series over at Lifebridge Health for the coming week.

• How Not To Grow A Beard Month continues apace, and the first week finds me quite humbled by the donations given on my behalf for breast cancer research. Thus far, all participants have raised $1,266 total, and we still have over three weeks left to go in the month! Check out my entries for Day 3, Day 4, Day 5, Day 6, and Day 7, and if you haven’t done so yet, please consider donating to this worthy cause.

• 15:25 Cmar-bloggery: : Happy Saganday! bit.ly/44lP2h #
• 16:34 3 day wait for genius bar appointment? Lovely. On-site tech support paradigm... breaking... #
• 17:36 @bjmclaughlin Likely not. 'tis a battery problem. #
• 17:52 At @ConstellationBo for National Bookstore Day. A certain book by @jchutchins is a staff pick... twitpic.com/oobam #
• 19:36 Dinner at the Harryman House, with Hopocalypse ale on draft = wonderful. twitpic.com/oot8j #
• 20:00 @jbcrail It's "Growing Carnivorous Plants" that @scifilaura just got. Awesome book. She has no devious plans... none at all. Nope. #
• 22:53 Cmar-bloggery: i'm in disguise, or #HoNoToGroABeMo Day 7 - bit.ly/4dwm66 #
• 23:23 @alphasis We watched it earlier tonight, as well. I greatly approve. Here's hoping they can keep it up. #

Originally published at Saint Nickanuck of the Tundra. You can comment here or there.

“Science is more than a body of knowledge – it’s a way of thinking, of skeptically interrogating the universe with a fine understanding of human fallibility.”

Today is the first annual Carl Sagan Day event, which is being held to celebrate his life and contributions in conjunction with the 75th anniversary of his birth coming up on Monday. A full roster of the day’s events at Broward College in Davie, FL, can be found here, and many of the goings-on will be streaming live here.

Carl’s perspective as a humble scientist and a captivating storyteller is an inspiration to many, myself included. Even narrowly looking at my own field, many challenges that I face in my work with infectious diseases – public perceptions of the nature of the influenza virus, or unfounded vaccine fears, for two of many examples – are a directly tied to many of the issues Sagan was passionate about, including a global lack of critical thinking education, and an almost willful misunderstanding of science and medicine by some segments of the public. Continuing his work is critical not only for the betterment of public health, but also for the well-being of our global society as we continue to move into a more scientifically nuanced and technologically advanced era.

Below, in three sections, is Carl’s last televised interview. It touches on many topics, including pseudo-science in a scientifically-driven world, critical thinking v. belief, and his own illness. As with any video he was involved with, it is entertaining and thought-provoking. The quote above, and those below, are taken from this interview. Enjoy, and happy Saganday!

“We’ve arraigned a society based on science and technology, in which nobody understands anything about science and technology, and this combustible mix of ignorance and power is soon going to blow up in our faces… who is running the science and technology in a democracy if the people don’t know anything about it?”

“People read stock market quotations and financial pages, look at how complex that is… people are able to look at sports statistics… understanding science is not more difficult.”

“Science is after the way the universe really is, and not what makes us feel good… a lot of the “competing” doctrines are after what feels good, and not what is true.”

“If the universe does not comply with our predispositions, we have the wrenching obligation to accommodate to the way the universe really is.”