On July 6th of 2007 Buzz Williams resigned as the men’s basketball head coach at the University of New Orleans after only one season. His replacement for the next four seasons would be Joe Pasternack. He is the team’s third coach in three years.

This is Pasternack’s first head-coaching job, after serving as assistant coach in California for the previous eight seasons. The University of New Orleans’ basketball team’s home court, Lakefront Arena, was still not restored after its destruction from Hurricane Katrina. The team would practice and play in a high school gym, one of many challenges that Joe Pasternack had to face during his career as coach there.

The one factor that was in his favor, is the fact that he is originally from New Orleans. His parents had lost their home in the hurricane and he understood that recovery, whether of a home, a home court, or a basketball team as a whole demands much patience and hope.“I felt like I wanted to be back home, regardless of Katrina,” Pasternack said. “But the storm made it even more of a calling.”

Joe Pasternack has resigned as men’s basketball head coach of the University of New Orleans’ team in order to become an assistant coach at the University of Arizona’s men’s basketball team under head coach Sean Miller. “It was very difficult for me being from New Orleans to leave the city that I love,” Pasternack said. “But this was an opportunity, and I’ve looked at many opportunities in the past two years I let go by the wayside, but this was an opportunity I couldn’t pass up. Sean Miller is the total package. He’s one of the top coaches in all of college basketball.”

Joe Pasternack’s contract at the University of New Orleans was very close to its expiration date, and the plan was for him to sit down with Athletic Director Amy Champion in order to decide on a new deal. That plan completely changed once coach Miller called him. Miller considered a number of candidates for the assistant coach job, but Pasternack’s impressive reputation and wide experience lead Miller to decide that he is the best candidate.

“To me, I just want to be in a situation where we’re competing for Final Fours and national championships,” Pasternack said. “That to me is the most important thing for me and my family, to be in a situation where we can compete at the highest level. This is one of the elite programs in all of America. When you look at Arizona basketball, you can put them at the same level as Duke, Kentucky, North Carolina, Kansas.”

Prior to his coaching career at the University of New Orleans, Pasternack was an assistant coach at California for eight seasons, and also served as a student manager under Coach Bob Knight at Indiana. Coach Knight helped Pasternack to make his decision, and told him that the University of Arizona job is too good to pass up.

I was in London recently and, pleasingly, was running a little ahead of schedule. I therefore spent a fascinating hour wandering around the latest exhibition in the Wellcome Trust building ‘Brains: Mind as Matter’*. The exhibition charts the history of humanity’s quest to understand and describe the brain, ‘the most complex entity in the known universe’.

Image Credit: dierk schaefer

In antiquity, apparently, the brain was considered a less useful organ than the heart and liver. However, by Roman times, the brain was believed to be the seat of the mind and the soul, and its activities were thought to occur in the ventricles, rather than the brain tissue itself. Interest in the brain grew throughout the Middle Ages, and for many centuries thereafter, having a large brain was considered an asset.  Indeed, popular culture in the 18^th century held that humans were different from animals as we evolved from a large-brained ancestor. The Piltdown remains, discovered in 1912, were purported to confirm this, but were later shown to be an elaborate hoax.

The importance of having a large brain continued to interest many in Victorian times and led to the practice of preserving the cerebral matter of particularly intelligent or villainous individuals to permit future study. The exhibition includes the preserved brain tissue of serial murderer William Burke  and an influential American suffragist, Helen Hamilton Gardner,  who argued that the female brain was not “demonstrably different from that of a man under the same conditions and with the same opportunities for development”.  Charles Babbage who invented the first computer, also bequeathed his brain to permit further study.

Image Credit: J E Theriot

Public interest in the brain prompted the birth of anthropometry, and the less useful pseudoscience of phrenology – the study of the contours and shape of the human skull to derive information about an individual’s personality and emotions. Despite the limitations of this approach, it introduced an important concept: that cerebral functions were localised to certain areas of the brain. Head measurements were also used to justify racial and gender-related stereotypes. There is a fascinating poster in the exhibition explaining that although women have smaller brains than men, many are just as intelligent and should not be refused the vote based on smaller head size alone.

I found this exhibition to be enjoyable and stimulating with many thought-provoking pieces from across the world. It is also an illuminating study of how medicine and science have tried to grapple with the inexplicable. The mixture of half-truths believed about brains throughout the centuries reminds me that our knowledge today, while hopefully more accurate, is still not infallible.

* More details can be found at www.wellcomecollection.org/Brains or from the book accompanying the exhibition – ‘Brains: the mind as matter’, Kwint M, Wingate R. Wellcome Collection, 2012.

http://www.guardian.co.uk/culture/2012/apr/13/mind-as-matter-brains-wellcome

http://www.independent.co.uk/arts-entertainment/art/reviews/brains-the-mind-as-matter-wellcome-collection-london-7605935.html

http://www.reuters.com/article/2012/03/27/us-brains-exhibition-idUSBRE82Q0PT20120327

For all the goofiness that is SCAM, I never thought I would have a post with Cannibalism in the title.  The ability for humans to find imaginary healing properties in everything from duck liver and heart diluted 1:100 200 times, rhinoceroses horns, and waving hands over people to adjust energy fields that do not exist is remarkable.  Somehow I never thought Jeffrey Dahmer would be at the forefront of alternative therapies.

Wednesday evening while my wife was reading me the paper (it is how I usually consume the local newspaper, my wife reads stories she finds of interest out loud.  Otherwise I do not think I would bother with anything beyond the comics and sports page) she let it be known that Korean officials has confiscated medications containing aborted fetuses and stillborn babies.  Instead of the usual distracted, uh huh, that’s interesting, this caught my attention.  Say what?

She showed me the article.  There it was, in black and white, under the title “Human flesh pills seized.”  Korean customs officials confiscated 17,000 health capsules that contain human remains “most likely extracted from aborted fetuses or stillborn babies.” Forensic tests found a 99.7% match with human flesh.  Evidently unborn infants and placenta are believed to have medicinal properties in some parts of China and Korea.

Conformation bias kicked in big time. It is the kind of report I would assume to be true since it ties in with my understanding of traditional Chinese medicine, where they will grind up damn near anything to make a medical nostrum.   First tigers, now dead babies.  Stupid healers.

And there are parallels.  In parts of Africa, albino’s are dismembered and sometimes killed for body parts that are used by witch doctors to make potions that make the user healthy and wealthy (but not, evidently, wise).  As best I can tell, the potions and charms are used in rituals but not consumed, but the interwebs are not specific on the use of the albino parts. It is difficult to tell what is fact and fiction, although there is no doubt that albinos are being murdered for magical purposes.

The Wikipedia entry on the persecution of albinos has the following note at the top :

An editor has expressed a concern that this article lends undue weight to certain ideas, incidents, controversies or matters relative to the article subject as a whole. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message.”

I guess there is an opportunity for the pro murder and processing of albino’s into potions to weigh in with their side.  Sigh. The eternal quest for being neutral and telling both sides of the story.

I though the topic would be a nice addition to prior entries on Traditional Chinese medicine (TCM).  Then I thought wait a minute.  There are two topics about which I have expertise:  Infectious Diseases and SCAMs.  The Oregonian always gets it wrong when they have articles on these topics.  So why should it be correct this time?

As I thought about it, I have spent significant time in the byways and backwaters of TCM, looking for the odd and unusual therapies, and I have never heard of this form of medication.  Something that weird and repugnant would have been noticed long ago. Given the lack of veracity of the ingredients on the average bottle of TCM, even if it included ‘dead babies’ and ‘embryos’ on the label, I would be skeptical of the contents.

The article is only five paragraphs long, but rereading with a skeptical eye instead of confirmation bias suggests it doesn’t hold together.

There is this weirdly specific Auschwitz like description in the article:

The pills were composed on “ground stillborn fetus or babies that had been cut into small pieces and dried in gas ranges for two days, and then made into powders and encapsulated.

Although the Huffington Post suggested

dead babies whose bodies were chopped into small pieces and dried on stoves before being turned into powder.

And the Mail suggested more modern techniques

Overnight she dried it out on absorbent paper before slowly microwaving it on a low heat

My microwave doesn’t have low heat; maybe they mean low power.

So how do they know it is specifically babies and not placenta or other human tissues.  I am not certain as I cannot find a copy of the report in English.

The video report is in Korean and the only organs on screen look like placenta.  I could see nothing that looked like fetus

They comment a 99.7 % match with human tissue. Human tissue does not a fetus make.  I am of course limited by my lack of Korean and Google translation (which summarizes the entry with “saw culture terrible wrong against humanity is an act of singing.” I agree)  but I can’t find the forensic report on line, just references to it.  The video has some lab coated science done on screen, but I have no clue what they are really doing.  There are graphs and pipetting, so it must be valid.

There is something peculiar in  the missing 0.3%  that to my mind suggests someone wants to imply that  the source not quite 100% human, a goal if the message is not truth, but demonizing someone or something.  Those Chinese, eating dead babies.  They are not even completely human dead baby pills.

Is there any data to suggest the pills contain babies?  Nope.  Could it be placenta?  Almost certainly.  Placentas are popular the world over.   It is the one meat OK with vegans:

While some argue placentophagy is basically an act of cannibalism, many vegans think it’s okay to eat one’s own placenta, or a friend’s placenta, because no animal suffered for the meat.

Although half the human race, and certainly my wife, whose graphic description of pushing a bowling ball through a paper towel tube doesn’t sound like fun,  might argue with the last 6 words of that sentence. Not unsurpizingly the author is male.

How did they know such gruesome specifics about the manufacturing processes.  The video is not revealing and the written reports appear to be rewrites of the same article; the interwebs echo chamber can make research tedious.

All the comments on the beneficial effects of dead babies are in over the top sites about cannibalism  in China. Wouldn’t baby oil be cheaper? I  can  find no other independent references to  traditional healers who think dead baby pills are of benefit. I am sure there are a few Elizabeth Báthory wannabe’s , who think that consumption of human blood and body parts are of benefit.  Any alleged mystical/alternative health benefits from cannibalism are not mentioned on the interwebs outside of population control.

So I went a googling, an found all the reports started around 2000 and every instance I could find were on anti-abortion sites.  Ah.  No wonder the grisly description of the manufacturing process.  And the reports get really sensationalist with respect to China:

Usually, I washed the foetuses clean, and added ginger, orange peel and pork to make soup. After taking it for a while, I felt a lot better and my asthma disappeared. I used to take placenta, but it was not so helpful.”

and

The next day the reporter returned at lunch time. The doctor eventually emerged from the operating theatre holding a fist size glass bottle stuffed with thumbsized foetuses.

She said: ‘There are 10 foetuses here, all aborted this morning. You can take them. We are a state hospital and don’t charge anything.

‘Normally, we doctors take them home to eat – all free. Since you don’t look well, you can take them.

Most of the sites  are in the  same  sensationalist mode. When I was a medical student at the VA we would eat the dinner trays of patient who had been discharged or could otherwise not have their meals.  That is where I draw the line.

As best I can tell, the entire dead baby pill story is nonsense.  Whether started by Koreans or Pro-life proponents to aggravate their enemies and give succor to the faithful, I do not know.  Everything I can find suggests sensational, unverified reporting by people with an ax to grind.  It is another version of the blood libel, a common manifestation of bigotry, ignorance, and xenophobia. Accusations of  cannibalism has a long history as a form of propaganda used against the ’other’.

Glen Beck takes the opportunity to draw a parallel between dead baby pills and Obama’s stand on some aspects of health care.  That pretty much sums up the probable  reason this story exists.

And by the way, it is the Koreans who seem to be the market for dead baby pills, the Chinese are the re-processors.  It is the Koreans who have some ‘splanin to do.

While I am convinced the multiplicity of logical fallacies and its resultant  fundamental irrationality of humans, I also am convinced of the basic decency and goodness of most humans*.  The whole concept of eating dead babies goes against fundamental human nature, even if I do agree with the idea that for humans there is nothing unnatural, just untried.  Dead baby pill are  almost certainly not about alternative medicine, but demonizing your enemy, be it Chinese or the abortionist. Hmm.  Maybe I have to rethink the whole decency and goodness thing.  The idea of dead baby pills fails at the human level. It has about the same probability of being true as the The Protocols of the Elders of Zion.

This is by no means a definitive review of the topic, but none the less I call urban legend.  I await the Mythbusters to prove me right.  Watching the hosts  consume stillborn fetuses would make great television.

Asides
* I have always found the need of SCAM and anti-vaccine proponents to demonize their opposition to be the saddest part of their argument.  I try, not always with success, to remember it is the idea, not the person, that is the problem.  But then you have Gary Kevin Trudeau, Dr. Oz, and Robert Young, and it is the person after all.  Damned if you do, damned if you do.

Online processing consulting firm, Alliance Charge, announces its recent hiring of additional technical support employees to meet demand. Recently the consulting firm announced it has hired 10 information technology employees.
 
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The full-time technical support positions were filled by knowledgeable, experienced IT personnel, said Skinner. The new IT personnel will provide Alliance Charge customers with answers to questions regarding use and troubleshooting of online programs, as well as answers to any other technology related questions.

“Alliance Charge is happy to be able to hire additional staff and further grow as a family, we hope to continue growing and offer top-notch services,” said Skinner. “Alliance Charge is always on the hunt for the best solutions and employees,” said Skinner. “We simply want the best for our customers.”

Alliance Charge was formed in 2007 to play a bigger role in the online interactive and content management systems business. In addition, Alliance Charge provides payment consulting services as well as content management systems development. Alliance Charge specializes in serving companies that require reliable online payment processing solutions. In addition, Alliance Charge focuses on providing solid solutions for companies that want to leverage their payment processing capabilities.

More About Alliance Charge
Online processing consulting firm, Alliance Charge, is a subsidiary of Myroxon Holdings Ltd, a European based company. Alliance Charge provides a proprietary payment gateway directly linked to the banks across the globe, the company processes credit and debit card payments, verifies and processes e-Checks online, and more. Alliance Charge is considered an innovative global online processing consulting company. Alliance Charge was founded in 2007 to play a bigger role in the online interactive and content management systems business. Alliance Charge provides payment consulting services as well as content management systems development.

##

For additional information, interview, and image requests contact:
Paul Skinner
PR Manager
Alliance Charge

Joe Pasternack, previous head coach of the University of New Orleans’ men’s basketball team, will be the new assistant coach for the University of Arizona’s men’s team.

In his high school career, which took place in Metairie Park Country Day School, Pasternack played four years of high school basketball. He graduated from Indiana in 1999 with a bachelor’s degree in marketing.

Prior to his coaching career at the University of New Orleans, Joe Pasternack was a manager for the Indiana basketball team for four years under coach Bob Knight and was an assistant coach at California.

He is known for his passionate and workaholic approach to all of his given positions.

Guest blogger Trish Greenhalgh takes on a Twitter challenge

Sir Muir Gray, of evidence-based medicine fame, is a man who speaks his mind – often in 140 characters or fewer. “Show me a paper by a management academic,” he Tweeted, “that has changed the way we deliver health services” [and, implicitly, improved patient outcomes].

Part of me agreed with him, but I’m married to a management academic (“Oops sorry, better man than me,” Muir backpedalled), who helped me rise to Muir’s challenge.

We kicked off with a paper almost every clinician has heard of:

Image Credit: Julie Rybarczyk

Kaplan and Norton’s ‘balanced scorecard’, published in Harvard Business Review in 1992 and cited over 8000 times since [1]. The scorecard was aimed at company directors who wanted some quick (and, one is tempted to suggest, dirty) metrics to monitor what their customers thought of them and where they should direct their efforts for the future. It has certainly changed practice (many healthcare organisations use it), but we were not overly sold on its transferability to the healthcare setting.

In danger of winning the point but losing the principle, we tried to think of papers in management journals (which consist mainly of studies undertaken on US private-sector, product-oriented firms) whose findings had been applied to public sector, service-oriented organisations in the UK in a way that improved patient-relevant outcomes. We pretty much drew a blank.

One paper – Ramiller and Pentland’s critique of ‘variables centred’ organisational research [2] – gave a clue as to why.  Abstracted variance models aimed at producing generalisable truths about how organisations behave may appear scientific and rational (and promise findings that could be ‘rolled out’ to new settings), but in reality may have limited value since they divert the focus away from people taking action. These authors argue for a case study approach to complex change, in which human actors and action remain in frame, and the link between ‘input’ and ‘outcome’ is made using here-and-now narrative rather than abstracted, logicodeductive reasoning.

Talking of the narrative form in organisational research, there are a number of classics in this genre, including

• Weick on sensemaking. Staff need to make collective sense of organisational life; encouraging this sensemaking process is key to successful change efforts [3].

• Tsoukas [4] and Brown and Duguid [5] on organisational knowledge. Knowledge is embodied, socially developed and – to a metaphor originally coined by Wittgenstein – “rides along the rails laid down by shared practice”. This view of knowledge has been applied by Gabbay and le May in their brilliant work on ‘mindlines’ in health professionals [6].

• Van de Ven on the longitudinal case study method for organisational innovation [7]. However carefully you plan, innovation in healthcare organisations is invariably a messy, non-linear process that takes years rather than months and is characterised by shocks and setbacks. Again, don’t expect to document predictable and reproducible links between inputs and outcomes. My team’s systematic review of diffusion of innovations in healthcare drew heavily on Van de Ven’s empirical studies [8].

• Feldman and Pentland on organisational routines [9]. Routines are recurring patterns of interpersonal interaction that confer stability in an organisation but which also offer scope for change (when human actors choose to enact the routine differently). My team used this approach to surface the sophisticated ‘hidden work’ of receptionists in assuring medication safety in healthcare [10].

Incidentally, for a feisty argument over whether ‘variables-centred’ or ‘actor-centred’ paradigms are more robust, see Pfeffer’s Academy of Management Annual lecture from 1993 [11] and Van Maanen’s insouciant response [12].

We found many papers we wished had changed practice but probably hadn’t. For example:

• Fulop’s team showed pretty decisively that hospital mergers don’t save money [13].
• Currie and Guah predicted (accurately) the failure of England’s ill-fated £12.7 billion National Programme for Information Technology if policymakers continued to ignore stakeholders’ conflicting institutional baggage [14].

Image Credit: Adrian Boliston

Do healthcare policymakers take any notice of academic papers which warn that current approaches are unwise? My team didn’t think so. We drew on Tsoukas’ model of organisational knowledge to explain why [15].

A number of management papers emphasised the complex and context-bound nature of organisational phenomena. For example:

• Hawe and colleagues theorised complex interventions as events in complex systems [16]
• Lanham et al considered healthcare teams as complex systems and quality as an emergent property of those systems [17]
• Bate and colleagues looked at social movements as a force for change [18]. These movements – from feminism to the Arab Spring – work by linking an emerging identity (being part of the movement says something about who we are) with collective action (movements organise and do things). But they are inherently non-linear and cannot be ‘controlled’.

The topic of leadership is done to death in healthcare journals but most management academics have little interest in it, perhaps because it’s an example of a variable that has been abstracted from the person who has it!  But one paper – on the subtle approach of ‘tempered radicalism’ by Myserson and Scully – made it onto our list [19].

I’ve been avoiding Muir Gray recently. Whilst the exercise of attempting to “find a paper by a management academic that had changed practice and benefited patients” produced many insights into why organisational change in healthcare is difficult and unpredictable, the links between these papers and hard outcomes in healthcare were usually tenuous. If I were being pedantic, I would suggest that this is because Muir’s question implies a deterministic link between inputs (academic papers) and outcomes (patient benefits) whereas most of the literature listed above is theoretically incommensurable with such a link. But I suspect I should concede defeat and go buy him a drink. Or at least, give his book – on how to get it right when building healthcare systems – a gentle plug [20].

Acknowledgment: This blog is based on a discussion on Twitter and includes
various papers suggested by my followers.

Trish Greenhalgh is Professor of Primary Health Care at Barts and the
London School of Medicine and Dentistry, London, UK, and also a general
practitioner in north London.

1.         Kaplan RS, Norton DP: The balanced scorecard–measures that drive performance. Harvard Business Review 1993, Jan-Feb:71-147.

2.         Ramiller N, Pentland B: Management implications in information systems research: the untold story. Journal of the Association for Information Systems 2009, 10(6):474-494.

3.         Weick KE: Sensemaking in organizations. Thousand Oaks, CA:    : Sage; 1995.

4.         Tsoukas H: What is organisational knowledge. Journal of Management Studies 2001, 38(7):973-993.

5.         Brown JS, Duguid P: Knowledge and organization: A social practice perspective. Organization Science 2001, 12(2):198-213.

6.         Gabbay J, le May A: Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ 2004, 329(7473):1013.

7.         Van de Ven AH: Central probelms in the management of innovation. Management Science 1986, 32(5):590-607.

8.         Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organisations: systematic literature review and recommendations for future research. Milbank Q 2004, 82  581-629.

9.         Feldman MS, Pentland BT: Reconceptualizing organizational routines as a source of flexibility and change. Administrative Science Quarterly 2003, 48:94-118.

10.       Swinglehurst D, Greenhalgh T, Russell J, Myall M: Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. BMJ 2011, 343:d6788.

11.       Pfeffer J: Barriers to the advance of organizational science: paradigm development as a dependent variable Academy of Management Review 1993, 18(4):599-620.

12.       Van Maanen J: Style as Theory. Organizational Science 1995, 6:133-143.

13.       Fulop N, Protopsaltis G, Hutchings A, King A, Allen P, Normand C, Walters R: Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis. BMJ 2002, 325(7358):246.

14.       Currie WL, Guah MW: Conflicting institutional logics: a national programme for IT in the organisational field of healthcare. Journal of Information Technology 2007, 22:235-247.

15.       Greenhalgh T, Russell J, Ashcroft RE, Parsons W: Why National eHealth Programs Need Dead Philosophers: Wittgensteinian Reflections on Policymakers’ Reluctance to Learn from History. Milbank Q 2011, 89(4):533-563.

16.       Hawe P, Shiell A, Riley T: Theorising interventions as events in systems. American journal of community psychology 2009, 43(3-4):267-276.

17.       Lanham HJ, McDaniel RR, Jr., Crabtree BF, Miller WL, Stange KC, Tallia AF, Nutting P: How improving practice relationships among clinicians and nonclinicians can improve quality in primary care. Joint Commission journal on quality and patient safety / Joint Commission Resources 2009, 35(9):457-466.

18.       Bate P, Robert G, Bevan H: The next phase of healthcare improvement: what can we learn from social movements? Quality & safety in health care 2004, 13(1):62-66.

19.       Myerson DE, Scully MA: Tempered radicalism and the politics of ambivalence and change. Organization Science 1985, 6(5):585-600.

20.       Gray JAM: How to build healthcare systems. Offox Press Ltd: Oxford; 2011.

I am one week and three days from graduation. WOOOHOOOOOOOOO!

I am incredibly busy, which means I am also paralyzed in the face of all the crap I have to do, and procrastinating on the internet. Hello!

Yesterday I was a presenter for career day at my 7 yr old son’s school. I wore my white coat, wore scrubs, and brought my stethoscope and other tools. I presented in six classrooms (exhausting!), but started off in my own son’s first grade class.

I had an apron with sort of anatomically correct removable velcro body parts, which I used to play a matching game with the kids. If a kid guessed which organ I was describing (this organ is a muscle that pumps blood to the body!) then that kid got to put that organ on the volunteer kid who was the “body” wearing the apron. It was especially fun when we got to the kidneys and the large intestine. Poop! Pee! “EWWWWWWWW!”

There were only seven body parts, though, so I brought in my ragtag collection of toy doctor tools. Several people bought toy doctor sets for my kids when I got into medical school, so I had four plastic stethoscopes, a plastic syringe, toy otoscopes, etc. I passed those out to the kids who didn’t get to put on an organ, so they could guess what they were used for, and was one kid short. So, I gave that kid my coffee mug. I made a joke about how that was the most important doctor’s tool, since it helps keep doctors awake, and remarked on how much coffee I drink.

My son rose his hand, and offered, “She drinks beer, too!”

I said “And, goooodnight everybody!” and quickly defended myself. “I didn’t drink any this morning! I didn’t have any last night!” and spent the rest of the half hour trying to convince my son’s teacher that I don’t have a drinking problem.

*facepalm*

Cross posted at Mom’s Tinfoil Hat